Acutrak screw fixation for proximal
fifth metatarsal stress fracture
in Japanese soccer players.
Ryo Matsunaga, Takashi Sando, Takahisa Haraguchi,
Yoichi Katori, Kengo Yamamoto
<Acutrak screw fixation for proximal
fifth metatarsal stress fracture
in Japanese soccer players.>
<Ryo Matsunaga, Takashi Sando, Takahisa Haraguchi,
Yoichi Katori, Kengo Yamamoto>
My disclosure is in the
Final AOFAS Mobile App.
I have no potential conflicts with
this presentation.
Purpose
• Intramedullary screw fixation is adequate option
for fifth metatarsal stress fracture instead of
canulated cancellous screws.
• Yet, bending intramedullary screw could be
observed after surgical treatment.
• The aim of this study is to evaluate clinical results
of headless compression screw (Acutrak screw)
fixation for proximal metatarsal stress fracture in
Japanese soccer players.
Materials
Tokyo Medical University
Fifth metatarsal stress fracture: 27 feet, 27 cases
Acutrak screw® fixation: 17 feet, 17 cases
*Exclusion: Acute fracture, Revision surgery
Gender: Male 17, Female 0
Age: mean 17.9 years old
 Follow-up period: mean 14 months (range: 8-24 months)
 Sports Level
: Professional player (J-League) : 1 case
College soccer player
J-League youth player
High school player
: 9cases
: 6 cases
: 1 case
Methods
Acutrak screw®
Fracture location
Fracture type
Return to soccer
Radiographic evaluation after surgery
:Bone union
:Screw/Metatarsal ratio (SM ratio)
Recurrent case / non union case
Acutrak 4/5 or Acutrak Plus
Result: Fracture location
and type
Zone I：Tuberosity Avulsion FX
Zone II：Jones Fx
Zone III：Proximal diaphyseal stress FX
Zone III: 17 feet
Complete Fx : 8 feet
Incomplete Fx: 9 feet
Type 2: 17 feet
Torg classification
zone III
zone II
zone I
Type1：Acute fractures ,which were characterized by
a narrow fracture line and absence of
intramedullary sclerosis.
Type2：Those with delayed union ,with widening of the
fracture line and evidence of intramedullary
sclerosis.
Type3:Those with nonunion and complete obliteration
of themedullary canal by sclerotic bone.
【Lawrence SJ et al, 1993】
Clinical results and failure cases
Bone union : 10.7 weeks
Recurrent
Return to Soccer : 12.5 weeks
Age
Torg class.
Sports level
Union
Return
to soccer
Time
from surgery
18
Type II
College
11 wks
13 wks
4 mo.
21
Type II
College
8 wks
10 wks
6 mo.
19
Type II
Professional
8 wks
11 wks
8 mo.
Recurrent fracture: 18.0% (3/17)
Non-union 17
Type II
Non union: 6% (1/17)
J-League youth
Revision surgery using
bone grafting
Screw / Metatarsal ratio (SM ratio)
SM ratio: mean 0.68 (range: 0.62-0.73)
0.8
0.7
healed
Non-union
Recurrent
0.6
0.5
M
S
SM ratio
Inadequate screw length might widened fracture gap
and could cause delayed union.
【Amma, et al; The journal of Japanese Society of Clinical Sports Medicine: 2010】
Indication for surgical treatment
【Lehman et al, Foot and Ankle 1987】
Torg classification
type 1 & type2
Conservative treatment
type3
Surgical treatment
For athletes: surgical treatment > type 2
Conservative treatment involved 23% revision rate caused by recurrent
【Jesefsson et al, CORR 1994】
and non-union.
Returning to sports needed 30.0 weeks with conservative treatment,
and 15.6 weeks with surgical treatment. 【Chuckpaiwong et al, CORR 2008】
Current study: 12.5 weeks to return to Soccer
Our strategy:
Surgical treatment was recommended for all competitive athletes
Screw selection
Implant
Stiffness
Screw head Compression Intramedullary
problem
force
occupancy
Cannulated
Cancellous Screw
△
×
○
△
Herbert Screw
×
○
○
×
Charlotte Carolina screw
◎
×
△
△
Acutrak Screw
○
○
?
○
Acutrak screw would be optimal implant option for
preventing from recurrent fracture by its stiffness
and intramedullary occupancy.
Summary
 We evaluated clinical results of Acutrak screw fixation
for proximal metatarsal stress fracture in Japanese
soccer players retrospectively.
 The clinical results showed bone union in 10.7 weeks and
returning to soccer in 12.5 weeks after acutrak screw
fixation.
 Acutrak screw fixation is a good option for surgical treatment
in soccer players to return to sports early, however we
should pay attention to recurrent fracture after coming back
to their sports activity.
References
• Amma, et al. (2010). Intramedullary Screw Fixation of Jones Fractures.
The journal of Japanese Society of Clinical Sports Medicine: 18(3), 497-503.
• Chuckpaiwong et al. (2008). Distinguishing Jones and proximal diaphyseal
fractures of the fifth metatarsal. Clin Orthop Relat Res. Aug; 466(8): 1966–
1970.
• Jesefsson et al. (1994). Jones fracture. Surgical versus nonsurgical treatment.
Clin Orthop Relat Res. Feb;(299):252-5.
• Lawrence SJ et al. (1993). Jones' fractures and related fractures of the
proximal fifth metatarsal. Foot Ankle. Jul-Aug;14(6):358-65.
• Torg JS et al.(1984). Fractures of the base of the fifth metatarsal distal to the
tuberosity. Classification and guidelines for non-surgical and surgical
management. J Bone Joint Surg Am. Feb;66(2):209-14.