Ethical approvalĪll patients signed the informed consent. The articular surface area, tendon attachment area, and tendon diameter were measured with vernier calipers to an accuracy of 0.02 mm. Bone abnormalities such as osteoarticular degeneration, deformity, and tumour were excluded from the specimens using an X-ray. The specimens were of unknown age and gender and were randomly numbered from 1 to 8. The patients included 97 females and 125 males, aged 18–80 years, with 117 affected on the right side and 105 on the left side (Table 1).Īdditionally, we selected 8 unpaired lower limbs of adult Asian frozen cadaveric specimens, with 4 on the left side and 4 on the right side. We retrospectively analysed the Computed Tomography (CT) scan data of 222 patients with the avulsion fractures of the fifth metatarsal base, who met the selection criteria above and were admitted to our hospital from August 2015 to August 2020. This study is a retrospective audit of data already collected in the usual care of patients in our hospital. tendon transposition, ligament repair or internal fixation for fractures). hallux valgus, talipes equinus), history of foot surgery involving tendons, ligaments or bony structures (i.e. Exclusion criteria included: (i) avulsion fracture of the fifth metatarsal base comorbid with other fractures of the foot (ii) open fracture, pathologic fracture, or old fracture (iii) foot deformity or variation (i.e. Participants inclusion criteria included: (i) age ≥ 18 years (ii) avulsion fracture of the fifth metatarsal base, acute injury. Through comparison and verification of the two, we describe the fracture line characteristics for avulsion fractures of the fifth metatarsal base and clarify the mechanisms of the ligaments and tendons in this fracture. Therefore, in this study, we investigated the three-dimensional distribution of avulsion fractures of the fifth metatarsal base and conducted an anatomical study on the attachment site locations for the lateral band of the plantar fascia, peroneus brevis, and the peroneus tertius on the fifth metatarsal base. In addition, it is difficult for clinicians to choose treatment or predict prognosis with existing classifications for some special types. When the foot is subjected to an abnormal force, resulting in hindfoot inversion and forefoot plantarflexion, the unique anatomical structure of the fifth metatarsal bone directs the force to the proximal base of the bone, which is susceptible to avulsion fractures of the base.Ĭlinically, avulsion fractures of the fifth metatarsal base exhibit a diverse range of fracture morphologies, which have been beyond the description of existing classifications, but research on their fracture line characteristics is limited. The base of the fifth metatarsal bone is attached to several tendons and ligaments, including the peroneus brevis, the peroneus tertius, and the lateral band of the plantar fascia. Without treatment, it can lead to sequelae such as intractable pain and metatarsalgia. Metatarsal fractures occur in approximately 67/100,000 individuals each year, 70% of which are fifth metatarsal fractures, while avulsion fractures account for two-thirds of all fifth metatarsal fractures. With this knowledge, we propose a novel classification based on the injury mechanism, which can serve as a reference for clinical treatment and diagnosis. The lateral band of the plantar fascia and peroneus brevis play a major role, either separately or together, in avulsion fractures of the fifth metatarsal base. Resultsīased on the type of fracture line produced and the specific locations of the attachment points of the tendons or fascia, the avulsion fractures of the fifth metatarsal base can be classified into three types: type I predominantly involves the action of the lateral band of the plantar fascia type II predominantly involves the action of the peroneus brevis type IIIA involves the joint action of the peroneus brevis and lateral band of the plantar fascia with one fracture line, and type IIIB involves the joint action of the peroneus brevis and lateral band of the plantar fascia with two fracture lines. The fifth metatarsal base of 8 unpaired lower limbs of adult Asian frozen cadaveric specimens were also dissected to observe and measure the specific locations of the attachment points of the peroneus brevis, lateral band of the plantar fascia, and peroneus tertius to the fifth metatarsal base. The computed tomography (CT) scans were used to generate the 3-D images of all mapped fracture lines for the avulsion fractures of the fifth metatarsal base were compiled in an overall 3D image. Two hundred twenty-two patients with the avulsion fractures of the fifth metatarsal base, who were admitted to our hospital from August 2015 to August 2020. To clarify the injury mechanism of the avulsion fracture of the fifth metatarsal combining 3-dimensional (3D) fracture mapping with anatomical measurements.
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