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. The surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes was found to be one of the ideal treatment option for early return to full activity and relief of pain.To clarify the injury mechanism of the avulsion fracture of the fifth metatarsal combining 3-dimensional (3D) fracture mapping with anatomical measurements. There were no postoperative problems and functional loss on the operation lesions. ![]() The mean preoperative VAS score was 8.0☐.6 and the mean postoperative VAS score was 1.6☐.5 cm, which indicated significant difference (p=0.023). The mean AOFAS forefoot score was improved from 58.6±5.7 preoperatively to 95±5.4 postoperatively, which indicated significant difference (p=0.024). The AOFAS and VAS score was improved in all patients. ![]() The clinical results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) scoring system and statistically analyzed (SPSS ver. The mean age was 18.5 years and the mean follow-up period was 13 months. ![]() From February 2008 to December 2009, six athletic patients who had a symptomatic nonunion of fifth metatarsal base avulsion fracture underwent surgical excision of ununited bony fragment and they were followed for more than 12 months. The purpose of this study was to evaluate the clinical results of surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes.
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