Transverse Pinning for Metatarsal Fractures, Versus Antegrade Intramedullary Pinning for Metatarsal Fractures
Conditions
Keywords
neck and shaft Metatarsal Fractures
Brief summary
The aim of this prospective randomized controlled clinical trial study is to compare clinical, functional and radiological results of transverse pinning and antegrade intramedullary pinning for neck and shaft metatarsal fractures
Detailed description
Metatarsal fractures account for 35% of fractures of the foot and 5% of all skeletal fractures. They may be single or multiple, and isolated or associated with ligament lesions around the tarsometatarsal joint or with other fractures (1). Metatarsal fractures result from low-energy trauma in almost 85% of cases. Crush injury accounts for 41% of high-energy foot trauma. Fatigue fracture of metatarsals account for 38% of all fatigue fractures. The second and third metatarsals (M2, M3) are the most affected (2). The fifth metatarsal is involved in up to 70% of metatarsal fractures and approximately 80% of these are proximal (3). The overall aim of treatment is to restore the alignment of the metatarsals thereby maintaining the longitudinal and transverse arches of the forefoot. This allows normal weight distribution under the metatarsal heads. Nondisplaced fractures and fractures of the second to fourth metatarsals with displacement in the axial plane can be treated conservatively with protected weight bearing in a hard-soled shoe or boot for 4-6 weeks. Several surgical methods have been introduced to treat displaced fractures when satisfactory reduction and stability cannot be obtained by closed reduction techniques. Among the various surgical techniques available for the fixation of metatarsal fractures, include open reduction internal fixation by screw or mini plate , transverse pinning and antegrade intramedullary pinning Transverse pinning and antegrade intramedullary pinning have gained widespread acceptance due to their minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot (4). Antegrade intramedullary pinning technique using Kirschner wire (K-wire) allowed displaced metatarsal fractures to be easily reduced without opening the fracture site, and at the same time secured firm fixation without infringing the metatarsophalangeal (MTP) joint. Furthermore, the described method allowed immediate joint motion and caused no motion or pain limitation, and thus allowed rapid return to daily activities (5). The purpose of this study will be to compare the clinical, functional and radiological results of transverse pinning and antegrade intramedullary pinning for neck and shaft metatarsal fractures.
Interventions
PROCEDURETransverse Pinning for neck and shaft Metatarsal Fractures
⦁ Transverse Pinning Under spinal anaesthesia, the patient will be placed in the supine position. Under the guidance of an image intensifier, gentle longitudinal traction will be applied and percutaneous manipulation will be done using k wires and digital pressure.
PROCEDUREAntegrade Intramedullary Pinning for neck and shaft Metatarsal Fractures
Antegrade Intramedullary Pinning Under spinal anesthesia, the patient will be placed in the supine position. Under guidance of an image intensifier, a small incision will be made over the dorsal aspect of the foot at the proximal end of the fractured metatarsal. Soft tissue will be dissected, taking care not to injure neurovascular structures and extensor tendons. An entry hole will be then made with a 2.0-mm drill bit. A 1.6-mm K-wire will be prepared with distal end bent through 5 and the prepared K-wire will be held by T-handle. The K-wire will be inserted through the entry hole and will be advanced to the medullary canal
Sponsors
Sohag University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* ⦁ Age ≥ 18 years. * Both sexes. * Displaced metatarsal neck or shaft fractures. * Unstable fracture for which reduction could not be maintained after closed reduction. * Open fractures
Exclusion criteria
* ⦁ Fractures combined with Lisfranc injury. * Other concomitant fractures. * Non displaced fracture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ⦁ Time to bone union | 12 weeks | Immediate motion of the MTP joint and partial weightbearing in a stiff-soled shoe will be allowed. full weightbearing will be permitted 4 weeks after the operation. K-wires will be removed when pain subsided, which will be usually at 6 to 8 weeks for metatarsal head or neck fractures. For metatarsal shaft fractures, K-wires will be removed 3 months after the operation. union will be confirmed in radiographs taken at 12 weeks. Union will be confirmed by the presence of bridging trabeculae across the fracture site and resolution of fracture lines. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ⦁ Foot function using the Foot and Ankle Ability Measure (FAAM) | 6 months | Foot function will be evaluated by the Foot and Ankle Ability Measure (FAAM |
| ⦁ Pain intensity using the visual analog scale (VAS) | 6 months | Pain intensity will be assessed using the Pain intensity using the visual analog scale (VAS). (0 represents "no pain" while 10 represents "the worst pain imaginable"). |
| ⦁ Incidence of complications. ⦁ Incidence of complications. ⦁ Incidence of complications. ⦁ Incidence of complications.⦁ Incidence of complications. ⦁ Incidence of complications. | 6 months | — |
Countries
Egypt
Outcome results
None listed