Conservtive vs surgical management of stress fractures

NewsBot · Aug 23, 2014

Members do not see these Ads. Sign Up.
Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review
Wouter H Mallee et al
Br J Sports Med doi:10.1136/bjsports-2013-093246

Aim To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal.

Methods Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective studies. Two reviewers independently extracted data and assessed methodological quality. Main outcomes were return to sport and complication rate.

Results 18 studies were included (2 anterior tibia (N=31), 8 navicular (N=200) and 8 fifth metatarsal (N=246)). For anterior tibial fracture, no studies on initial surgery were eligible. Conservative treatment resulted in high complication rates and few cases returned to sport. For navicular fracture, a weighted mean return to sport of 22 for conservative and 16 weeks for surgical treatment was found. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Surgical procedures varied widely. For the fifth metatarsal fracture, weighted mean return to sport was 19 for conservative and 14 weeks for surgical treatment. Surgery consisted of intramedullary screw fixation or tension band wiring. For conservative methods, insufficient details were reported. Overall, there was a high risk of bias; sample sizes were small and GRADE level of evidence was low.

Conclusions Strong conclusions for surgical or conservative therapy for these high-risk stress fractures cannot be drawn; quality of evidence is low and subjected to a high risk of bias. However, there are unsatisfying outcomes of conservative therapy in the anterior tibia. The role of initial surgery is unknown. For the navicular, surgery provided an earlier return to sport; and when treated conservatively, weightbearing should be avoided. For the fifth metatarsal, surgery provided the best results. Treatment decision-making would greatly benefit from further prospective research.
Click to expand...

NewsBot · Nov 29, 2014

Management for common lower leg stress fractures in athletes
Elise M. Graham; Joshua Burns; Claire E. Hiller; Elizabeth J. Nightingale; Milena Simic
Physical Therapy Reviews

Background:
Stress fractures are a common overuse injury of bone, comprising up to 10% of all sports injuries, and resulting in pain and loss of game time. They are a consequence of repetitive loading forces on the bone and are often seen in response to an increase in activity or training load. They are especially common in the lower leg in athletes involved in running or jumping sports.
Objectives:
The objective of this review is to examine the management of stress fractures of the lower leg in athletes. The review discusses pathomechanism and etiology, and management, such as relative rest and activity modification, the use of pneumatic leg bracing, ultrasound, electrical stimulation, laser therapy, foot orthoses, nonsteroidal anti-inflammatory drugs (NSAIDs), less commonly used approaches, and surgery. The review also evaluates the specific management of individual stress fracture sites.
Major findings:
For stress fractures at low risk of delayed and nonunion, relative rest and activity modification is recommended. The literature regarding other modalities has had mixed results, with studies of low quality or based on military populations. Surgery may be necessary for stress fractures at high risk of delayed or nonunion that do not respond to aggressive nonweight-bearing management. The characteristics of specific stress fracture sites need to be considered throughout rehabilitation.
Conclusions:
It is difficult to draw conclusions from the literature regarding the many modalities clinically used to manage stress fractures. Further research into these modalities and research into specific stress fracture sites would be useful to guide practice.
Click to expand...

NewsBot · Dec 16, 2018

Is Use of Bone Cement for Treatment of Second Metatarsal Stress Fractures Safe? A Case Report.
McKissack HM et al
Cureus. 2018 Oct 9;10(10):e3436. doi: 10.7759/cureus.3436.

Metatarsal stress fractures are common injuries of the foot and can be a source of chronic pain without appropriate management. Conservative management is first line, but surgery may be indicated in athletes, cases of nonunion, and fractures of the fifth metatarsal. We report a case of a 34-year-old female who presented to clinic for intractable pain of the left foot secondary to a stress fracture of the left second metatarsal, which had been previously treated with injectable acrylic bone cement. Calcium sulfate hydroxyapatite cement has a multitude of applications in orthopedic surgery, but to our knowledge no studies have documented its use in the treatment of metatarsal stress fractures. Our findings suggest that injectable calcium sulfate hydroxyapatite cement is not a suitable stand-alone treatment in fractures of the second metatarsal.
Click to expand...

NewsBot · Nov 10, 2020

A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management
Karen L. Troy PhD Irene S. Davis PhD, PT Adam S. Tenforde MD
06 November 2020 https://doi.org/10.1002/pmrj.12518

Metatarsal bone stress injuries (BSI) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology and biomechanics. In this paper, anatomical factors including foot type, metatarsal lengths, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biological factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Are there effective nonsurgical treatments of bunions?

Foot and ankle surgery from the National Surgical Quality Improvement Program

Improvements in Sleep Quality Following Surgical Intervention for Foot Problems

Vascular anatomy of the first metatarsal bone and surgical implications

Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers

Prices for Surgical Management of End-Stage Hallux Rigidus

Manual Therapy in Patients After Surgical Fixation of Ankle and/or Hindfoot Fracture

Share This Page