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Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management.

Publication ,  Journal Article
Vertullo, CJ; Glisson, RR; Nunley, JA
Published in: Foot Ankle Int
September 2004

BACKGROUND: Reports of nonunion of proximal fifth metatarsal fractures treated by internal fixation indicate that current fixation methods do not always adequately address the stresses to which the bone is subjected during ambulation. In particular, the insertion sites of the peroneus brevis and peroneus tertius tendons on the fifth metatarsal suggest that their actions can impose torsional stresses on the areas of the bone in which Jones fractures and stress fractures occur. Intramedullary screw fixation, however, offers little resistance to rotation of the proximal and distal fragments relative to one another. METHODS: To determine the potential for the existence of torsional stresses in the fifth metatarsal during post-operative ambulation, a simplified cadaver model of single-limb stance was used in which cadaver feet were subjected to concurrent axial and tendon forces while monitoring the outputs of stacked rosette strain gauges placed at the typical sites of Jones and stress fractures. Principal strain and shear strain magnitudes and directions were measured. RESULTS: The shear strain magnitudes and strain axis directions indicated the presence of torsional stresses in the underlying bone potentially capable of causing internal rotation of the proximal fragment relative to the distal end of the bone. CONCLUSIONS: This finding has implications for the treatment of both Jones fractures and stress fractures of the proximal fifth metatarsal. An internal fixation device that has the capability to resist torsion as well as tension and bending would appear optimal to treat these fractures.

Duke Scholars

Published In

Foot Ankle Int

DOI

ISSN

1071-1007

Publication Date

September 2004

Volume

25

Issue

9

Start / End Page

650 / 656

Location

United States

Related Subject Headings

  • Stress, Mechanical
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Male
  • Humans
  • Fractures, Stress
  • Fractures, Bone
  • Fracture Fixation, Internal
  • Female
 

Citation

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Vertullo, C. J., Glisson, R. R., & Nunley, J. A. (2004). Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management. Foot Ankle Int, 25(9), 650–656. https://doi.org/10.1177/107110070402500910
Vertullo, Christopher J., Richard R. Glisson, and James A. Nunley. “Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management.Foot Ankle Int 25, no. 9 (September 2004): 650–56. https://doi.org/10.1177/107110070402500910.
Vertullo CJ, Glisson RR, Nunley JA. Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management. Foot Ankle Int. 2004 Sep;25(9):650–6.
Vertullo, Christopher J., et al. “Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management.Foot Ankle Int, vol. 25, no. 9, Sept. 2004, pp. 650–56. Pubmed, doi:10.1177/107110070402500910.
Vertullo CJ, Glisson RR, Nunley JA. Torsional strains in the proximal fifth metatarsal: implications for Jones and stress fracture management. Foot Ankle Int. 2004 Sep;25(9):650–656.
Journal cover image

Published In

Foot Ankle Int

DOI

ISSN

1071-1007

Publication Date

September 2004

Volume

25

Issue

9

Start / End Page

650 / 656

Location

United States

Related Subject Headings

  • Stress, Mechanical
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Male
  • Humans
  • Fractures, Stress
  • Fractures, Bone
  • Fracture Fixation, Internal
  • Female