Die Behandlung der Metatarsale-V-Basisfraktur - eine retrospektive sowie prospektive Analyse

Functional treatment of avulsion fractures of the fifth metatarsal - Analysis of a retrospective and of a prospective study

by Anna-Lena Voelcker
Doctoral thesis
Date of Examination:2015-06-02
Date of issue:2015-06-02
Advisor:PD Dr. Stephan Sehmisch
Referee:Prof. Dr. Hans-Michael Klinger
Referee:Prof. Dr. Martin Oppermann
Persistent Address: http://dx.doi.org/10.53846/goediss-5105

 

 

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Abstract

English

The avulsion fracture of the fifth metatarsal is a common fracture of the foot. The mechanism of injury often is a supination and the fracture is caused by pull of the peroneus brevis tendon or by pull of the plantar fascia. There is general agreement in the literature about the indication for surgery in certain cases such as displaced fractures, or intraarticular extension or open fractures. Then the surgical risks and the higher costs are justified. If there is no surgical indication, the avulsion fracture is treated conservatively. In the literature you find many different methods of functional treatment. This paper shows retrospectively the treatment and the healing process of the avulsion fracture of the fifth metatarsal from 1996 to 2005 in the University Hospital of Göttingen. To evaluate the treatment and the healing process time of bony consolidation and time of full weight-bearing were documented. In addition, three conservative therapy concepts could be compared in a prospective study. The first group of patients was treated with a soft cast and early functional physiotherapy. The second group received a closed soft cast and physiotherapy after six weeks. The third group was treated with an ankle-splint and as group 1 with immediate physiotherapy. The ankle-splint is a new concept of immobilization. It is not the fractured area immobilised, but the causal movement of the mechanism of injury (usually inversion) is prevented. In the comparative evaluation is especially with regard to the bony consolidation obvious, that the ankle-splint with early functional physiotherapy is the best therapeutic concept. Patients in the retrospective study, often treated with the Geishashoe, had a longer healing process (8.4 weeks, ankle-splint four weeks). The other two groups of prospective study (soft cast with / without early functional physiotherapy) have less good results than the ankle-splint (bony consolidation in seven and 7.7 weeks).
Keywords: fifth metatarsal; avulsion fracture; functional treatment; ankle-splint
 
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