Using the Herbert screw for intramedullary screw fixation to treat metatarsal stress is an effective technique for high-level athletes, according to a new study.
“Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still be investigated,” the researchers of the study, “The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes” wrote.
The research, published online on October 15, 2021, in The American Journal of Sports Medicine, analyzed outcomes of intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures.
The study enrolled 37 high-level athletes (Tegner activity ≥7) who underwent the procedure between August 2005 and August 2017. The minimum follow-up period for them was 2 years.
Time to reach bone union, time to return to original level of sport participant and treatment failures and complications were all reviewed by the researchers. So was the effect of intraoperative plantar gap widening caused by the screw insertion.
The patients were categorized by whether they had an intraoperative plantar gap (widening of 1mm or larger or not (widening less than 1mm).
Overall, all of the patients achieved both bone union and return to their original sport level without treatment failures or complications such as delayed union, nonunion or refracture.
The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group and the gap group, there were no significant differences in the time to bone union (p = .392) or to return to sport (p = .399). There was no correlation between intraoperative plantar gap widening and time to obtain bone union (r = 0.131; p = .428) or to return to sport (r = 0.160; p = .331).
The researchers wrote, “The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique.”
The research team included. Shota Morimoto, M.D., Tomoya Iseki, M.D., Ph.D., and Toshiya Tachibana, M.D., Ph.D., all from Hyogo College of Medicine, Nishinomiya, Hyogo, Japan as well as Takatoshi Morooka, M.D., Ph.D. and Shinichi Yoshiya, M.D., both of Nishinomiya Kaisei Hospital, Nishinomiya, Hyogo, Japan. Juichi Tanaka, M.D., Ph.D., of Ogihara Orthopaedic Hospital, Kobe, Hyogo, Japan was also an author of the study.
