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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Effect Of Peroneus Brevis Tendon Anatomy On Stability Of Fractures At The Fifth Metatarsal Base
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The Effect Of Peroneus Brevis Tendon Anatomy On Stability Of Fractures At The Fifth Metatarsal Base

机译：腓骨短肌腱解剖对第五On骨底部骨折稳定性的影响

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Objectives: Fractures of the fifth metatarsal base are not uncommon. Both fracture management and outcomes can differ greatly depending on fracture location. The purpose of the present study is to evaluate the influence of the peroneus brevis (PB) tendon on proximal fifth metatarsal fracture stability. We hypothesize that proximal fifth metatarsal fractures distal to the PB tendon footprint are inherently less stable than more proximal fractures. Methods: We utilized 5 matched pairs of fresh-frozen cadaveric specimens. We carefully exposed the 5th metatarsal and PB tendon. We measured the length of the PB insertion at the base of the fifth metatarsal with calipers. The PB and Achilles tendons were then whip-stitched proximally to facilitate loading. A custom leg holder was fabricated to allow loading and fluoroscopic evaluation. Two conditions were utilized for biomechanical testing; (1) a simulated fracture distal to the PB insertion (Jones equivalent) and (2) a simulated fracture within the footprint of the PB insertion (avulsion equivalent). All fractures were carefully created with a narrow osteotome. Following fracture creation, the plantar flexed foot was statically loaded through the Achilles and PB tendons. Oblique images with and without loading and digital measurements were performed to evaluate for fracture separation. We utilized a paired student T test and intraclass correlation coefficient (ICC) for all statistical analysis. Results: The average length of the PB footprint was 15.2 mm. Compared to fractures within the PB footprint, fractures distal to the PB tendon insertion demonstrated greater fracture widening following loading of the PB tendon. Fractures within the PB footprint widened 0.4 mm on loading (Figure 1A to 1B) compared to 1.1 mm of widening in the fractures distal to the PB insertion (Figure 1C to 1D). This difference was significant (p = 0.02). Intraobserver reliability for all radiographic measurements showed substantial agreement. Conclusion: Avulsion fractures at the base of the fifth metatarsal have much better healing potential than the so-called Jones fracture. Poor vascularity has been cited as a cause for poor healing potential following Jones fractures. The principal findings of this study demonstrate that proximal fifth metatarsal fractures distal to the PB insertion are significantly more unstable than more proximal fractures. In our study, the PB exerts a deforming force on the proximal fragment of fractures distal to the PB footprint. This deforming force was less pronounced in fractures within the PB footprint. Our findings help support the notion that a mechanical component may contribute to the poor healing potential of Jones fractures secondary to deformation exerted by the PB tendon. This would help explain why screw fixation is often recommended to address Jones fractures. Further research is needed to evaluate the biomechanics of these fractures.
机译：目的：第五meta骨基部骨折并不少见。根据骨折的位置，骨折的治疗和预后可能会大大不同。本研究的目的是评估腓骨短肌（PB）肌腱对近端第五fifth骨骨折稳定性的影响。我们假设PB肌腱足迹远侧的第五fifth骨近端骨折固有地不如更多的近端骨折稳定。方法：我们使用了5对匹配的新鲜冷冻尸体标本。我们仔细暴露了第五5骨和PB肌腱。我们用卡尺测量了第五个meta骨底部的PB插入长度。然后将PB和跟腱腱向近端鞭缝，以利于负荷。定制的腿架被制造以允许装载和荧光检查。利用两个条件进行生物力学测试; （1）PB插入远端的模拟骨折（琼斯当量），（2）PB插入足迹内的模拟骨折（撕脱当量）。所有骨折均由狭窄的骨凿精心制作。产生骨折后，通过跟腱和PB腱静态加载the屈脚。进行带有和不带有加载的斜图像和数字测量以评估骨折分离。我们利用配对的学生T检验和组内相关系数（ICC）进行所有统计分析。结果：PB足迹的平均长度为15.2 mm。与PB足迹内的骨折相比，PB肌腱插入远端的骨折在PB肌腱负荷后表现出更大的骨折扩展。 PB足迹内的骨折在加载时会扩大0.4 mm（图1A至1B），而PB插入远端的骨折会扩大1.1 mm（图1C至1D）。该差异是显着的（p = 0.02）。所有射线照相测量的观察者内可靠性均显示出基本一致性。结论：第五meta骨底部撕脱性骨折比所谓的琼斯骨折具有更好的愈合潜力。琼斯骨折后，不良的修复潜力被认为是血管稀疏的原因。这项研究的主要发现表明，在PB插入远端的第五fifth骨近端骨折比更多的近端骨折更不稳定。在我们的研究中，PB在PB足印远端的骨折近端碎片上施加变形力。这种变形力在PB足迹内的骨折中不太明显。我们的发现有助于支持以下观点：机械成分可能导致继发于PB肌腱变形的琼斯骨折的不良愈合潜力。这将有助于解释为什么通常建议使用螺钉固定来治疗琼斯骨折。需要进一步的研究来评估这些骨折的生物力学。

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