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13-03-2013 | Orthopaedics | Article

MT-5 fracture rare but troublesome in young footballers


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medwireNews: Researchers have characterized metatarsal five (MT-5) fractures in male footballers, finding injuries to be rare, occurring most commonly among young players, and associated with a risk for healing complications.

The findings, published in the British Journal of Sports Medicine, show that MT-5 fractures made up just 0.5% of 13,754 injuries reported by players in 65 elite European football teams between 2001 and 2012.

This gave a rate of 0.04 injuries per 1000 hours of exposure, equivalent to a team of 25 players experiencing a MT-5 fracture once every fifth season, explain Jan Ekstrand (Linköping University, Sweden) and C Niek van Dijk (University of Amsterdam, the Netherlands).

Initial X-ray revealed 45% of the fractures to be Torg type II stress fractures and 46% Torg type I acute fractures.Overall, 67% of the 67 MT-5 fractures reported were primary fractures and 33% were refractures. The majority (97%) of the primary fractures occurred toward the base, with just one avulsion of the tuberosity found.

Overall, 76% of the 37 players with base fractures underwent surgery and returned to training after an average of 80 days, of whom seven players (25%) experienced refracture a mean of 75 days later. The nine players who received conservative treatment returned to football after an average of 74 days and five suffered refracture at a mean of 136 days. One player experienced nonunion at 98 days.

Thus, players who underwent surgery had a higher healing rate than those given conservative treatment (75 vs 33%), but there was no significant difference in the number of lay-off days in the two treatment groups (80 vs 74 days).

The researchers note that players with an MT-5 fracture were significantly younger than the average age of the team players (23 vs 25 years), with 32% of MT-5 fracture patients aged less than 21 years and just 22% aged over 25 years. Players with and without MT-5 fractures did not differ significantly with regard to height, weight or body mass index.

Forty percent of fractures occurred preseason, 69% in the nondominant leg, and 45% of players reported prodromal symptoms, such as pain in the lateral side of the foot before the fracture. Most (69%) MT-5 fractures occurred in non-contract situations but 87% were reported as trauma and 13% as overuse.

"This study shows that attention must be paid to prodromal signs and radiological predictors, because they can alert us, and hence prevent the development of a true MT-5 fracture. If a fracture does occur, surgical treatment is advised with a prognosis of 80 days to full activity," write Ekstrand and van Dijk.

"Owing to the fact that this injury is rare with a high non-union rate, we emphasise the need for dedicated stress-fracture centres," they add. "This could benefit both the patient and the scientific evidence in this field of sport injuries, which is currently very scarce."

By Lynda Williams, Senior medwireNews Reporter

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