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This is when the patient finally reached Fakeeh University Hospital, where Dr. Muhammad Khalifa, Orthopedic Foot and Ankle Specialist, Fakeeh University Hospital, took charge of his case.

The Case

A 20-year-old professional football player recently visited Fakeeh University Hospital with pain in the right foot. The player had complained of the same issue 9-10 months back, at which time it was diagnosed with stress fracture of 5th metatarsal (at a different hospital). After adequate X-rays and MRI reports, the patient was advised rest for 4-6 months, and to avoid any playing or training.

After the rest period, the patient felt recovered and re-started playing football. However, he again was experiencing the same pain and this time, he took a consultation from a professor of Foot & Ankle in Switzerland. His radiology reports showed no signs of stress fracture and the patient was given 3 injections for the condition. The patient recovered and again resumed football, only to experience the pain again.

This is when the patient finally reached Fakeeh University Hospital, where Dr. Muhammad Khalifa, Orthopedic Foot and Ankle Specialist, Fakeeh University Hospital, took charge of his case.

Detailed diagnosis

Patient arrived at the hospital with mild limping and no apparent deformity. However, it was a necessity to again perform a complete and detailed diagnosis. After which, the results revealed that the patient indeed still had stress fracture of the 5th metatarsal. Additionally, there was localized swelling and tenderness on the base of 5th metatarsal, callosities on medial aspect of MPJ & IPJ, intramedullary sclerosis and lack of periosteal callus reaction. Final diagnosis was made as: Stress fracture of 5th metatarsal of the right foot.

Early Surgical Management

Considering the sensitivity of the patient’s age, career and the overall case history, Dr. Khalifa took the decision to adopt an early surgical management. As per literatures, it is better to opt for operative treatment of the 5th metatarsal fractures, rather than other modes of treatments. Dr. Khalifa was aware that an early surgical management also results in smaller number of delayed unions or non-unions, as compared to conservative treatments.

The goal of an early surgical management is also to minimize the risk of non-union and recurring fractures. Most importantly, to ensure that the athlete can get back to active sports as soon as possible without hassles.

“In such cases, timely intervention and proper diagnosis is vital. When we are handling the delicate life and career of an athlete, an accurate treatment path should be taken. We were able to successfully perform the surgery at the right time for the patient, before his condition could go worse. What further helped us was that Fakeeh University Hospital has the right equipment to perform all such advanced surgeries, with accuracy and faster recovery periods,” says Dr. Muhammad Khalifa, Orthopedic Foot and Ankle Specialist, Fakeeh University Hospital.
 

Faster recovery

The patient was admitted immediately and a percutaneous screw fixation of metatarsal was performed. The post-surgical recovery was uneventful. And he was discharged on the same day, with post-operative and rehabilitation instructions.

These included:

  • Short period of non-weight bearing (1-2 weeks)
  • Protected weightbearing and beginning therapy focusing on range of motion
  • Non-impact aerobic exercises
  • Commence running and impact activities at 6 weeks, if signs of radiographic callus
  • FOCUSED shock waves recommended at the fracture site (2-3 sessions)
  • Avoid Set-Piece Kick by left leg and curve running on right side

Benefits of Early Surgical Management

  • Medical literatures point it is better to opt for operative treatment of the 5th metatarsal fractures, rather than other modes of treatments, particularly in professionals
  • It results in smaller number of delayed unions or no non-unions, as compared to conservative treatments
  • It ensures quicker recovery time
  • It is less complex and has less hassles

References

  1. Hetsroni I, Nyska M, Ben-Sira D, et al. Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture. Foot Ankle Int 2010; 31(3):203–11.
  2. Lee KT, Kim KC, Park YU, et al. Radiographic evaluation of foot structure following fifth metatarsal stress fracture. Foot Ankle Int 2011;32(8):796–801.
  3. Dameron TB Jr. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am 1975;57(6):788–92.
  4. Stewart IM. Jones’s fracture: fracture of base of fifth metatarsal. Clin Orthop 1960;16:190–8.
  5. Torg JS, Balduini FC, Zelko RR, et al. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for nonsurgical and surgical management. J Bone Joint Surg Am 1984;66(2):209–14.
  6. Zogby RG, Baker BE. A review of nonoperative treatment of Jones’ fracture. Am J Sports Med 1987;15(4):304–7.
  7. Lee KT, Park YU, Jegal H, et al. Prognostic classification of fifth metatarsal stress fracture using plantar gap. Foot Ankle Int 2013;34(5):691–6.
  8. DeLee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med 1983;11(5): 349–53.
  9. Lee KT, Park YU, Young KW, et al. Surgical results of 5th metatarsal stress fracture using modified tension band wiring. Knee Surg Sports Traumatol Arthrosc 2011;19(5):853–7.
  10. Mindrebo N, Shelbourne KD, Van Meter CD, et al. Outpatient percutaneous screw fixation of the acute Jones fracture. Am J Sports Med 1993;21(5):720–3.
  11. Portland G, Kelikian A, Kodros S. Acute surgical management of Jones’ fractures. Foot Ankle Int 2003;24(11):829–33.
  12. David Miller, Daniel Marsland, Mary Jones & James Calder, Early return to playing professional football following fixation of 5th metatarsal stress fractures may lead to delayed union but does not increase the risk of long-term non-union, Knee Surgery, Sports Traumatology, Arthroscopy volume 27, pages2796–2801 (2019)

Dr. Muhammad Khalifa

Specialist Orthopedic Surgeon
Fakeeh University Hospital, Dubai

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