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Frakturen der Metatarsale Fünf Basis – eine Neubetrachtung

Fractures of the base of the V metatarsal bone—current concepts revised

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Zusammenfassung

Frakturen der Basis des 5. Mittelfußknochens gehören zu den häufigsten Verletzungen des Fußes und des Sprunggelenks. Trotz dieser Häufigkeit und obwohl mittlerweile einige Studien zu diesem Thema vorliegen, erfolgt die Behandlung oft nicht entsprechend der verfügbaren Evidenz. Dies liegt an einer uneinheitlichen Terminologie und daran, dass die vorhandene Evidenz nicht ausreichend wahrgenommen wird. Ziel dieser Übersichtsarbeit ist es, die aktuellen Klassifikationen, die verfügbaren Therapiestudien und die daraus resultierenden Behandlungsempfehlungen darzustellen. Als „Jones Fraktur“ werden unterschiedliche Frakturentitäten bezeichnet; der Begriff sollte daher nicht mehr benutzt werden. Meist erfolgt die Einteilung nach Lawrence und Botte (L&B) in 3 Zonen. Die verfügbaren Studien zeigen aber, dass sich Frakturen der L&B Typen I und II bezüglich ihrer Prognose nicht unterscheiden. Beide können unter funktioneller Therapie mit schmerzabhängiger Vollbelastung erfolgreich zur Ausheilung gebracht werden. Diese Unterscheidung scheint daher nicht sinnvoll. Vielmehr sollten Frakturen der L&B Typen I und II als epi-metaphysäre Frakturen zusammengefasst werden. Auch dislozierte, intraartikuläre und mehrfragmentäre Frakturen in diesem Bereich lassen sich funktionell mit guten Ergebnissen behandeln. Die Frakturen am Übergang von Meta- zu Diaphyse (L&B Typ III, am distalen Ende der Artikulation von Metatarsale IV und V) weisen nach konservativer Therapie eine hohe Rate an schmerzhaften Pseudarthrosen auf. Sie sollten primär operativ mittels geschlossener Repositino und intramedullärer Schraubenosteosynthese versorgt werden.

Abstract

Fractures of the base of the fifth metatarsal bone are one of the most frequent fractures to the foot and ankle. Despite the high frequency and although a number of studies are now available, treatment frequently does not follow the available evidence. Among the reasons is the inconsistent terminology used and that the studies available are neglected. The aim of this review is to present the current classifications, the available treatment studies and to derive evidence-based treatment recommendations. The term “Jones fracture” has been used inconsistently for different fracture entities and should, therefore, not be used anymore. Fractures are mostly classified according to Lawrence and Botte into three zones. However, the available studies demonstrate that type I and type II fractures according to Lawrence and Botte do not differ with respect to the prognosis. Both fractures can be successfully healed by functional treatment with weightbearing as tolerated. Consequently, a differentiation between these two zones does not seem to be meaningful. Therefore, they should be summarized as epi-metaphyseal fractures. Even dislocated, intra-articular, and multifragmentary fractures in this region can be functionally treated with good results. Fractures in the meta-diaphyseal region (Lawrence and Botte type III, distal to the IV and V intermetatarsal articulation) demonstrate a high rate of symptomatic non-unions after conservative treatment. Therefore, these fractures should be primarily treated operatively by closed reduction and intramedullary screw fixation.

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Authors and Affiliations

  1. Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland

    S. F. Baumbach,  M. Braunstein &  H. Polzer

  2. Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland

    W. C. Prall &  W. Böcker

  3. Praxis für Hand‑, Ellenbogen- und Fußchirurgie, ATOS-Klinik Heidelberg, Heidelberg, Deutschland

    S. Polzer

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  1. S. F. Baumbach
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  2. W. C. Prall
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  5. S. Polzer
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Correspondence to H. Polzer.

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S.F. Baumbach, W.C. Prall, M. Braunstein, W. Böcker, S. Polzer und H. Polzer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Baumbach, S.F., Prall, W.C., Braunstein, M. et al. Frakturen der Metatarsale Fünf Basis – eine Neubetrachtung. Unfallchirurg 121, 723–729 (2018). https://doi.org/10.1007/s00113-018-0507-6

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