Shockwave Treatment vs Surgery for Proximal Fifth Metatarsal Stress Fractures in Soccer Players: A Pilot Study

Author:

Ramon Silvia12ORCID,Lucenteforte Giacomo34ORCID,Alentorn-Geli Eduard256ORCID,Steinbacher Gilbert25,Unzurrunzaga Rocío127,Álvarez-Díaz Pedro256,Barastegui David256,Grossi Sebastián25,Sala Esther258,Martinez-De la Torre Adrián9ORCID,Mangano Giulia Rita Agata10ORCID,Cuscó Xavier26,Rius Marta25,Ferré-Aniorte Alfred26ORCID,Cugat Ramón256

Affiliation:

1. Department of Physical Medicine and Rehabilitation, Hospital Quirónsalud Barcelona, Spain

2. Fundación García-Cugat, Barcelona, Spain

3. Policlinico Vittorio Emanuele, Università degli Studi di Catania, Catania, Italy

4. Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy

5. Mutualidad de Futbolistas Españoles–Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain

6. Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain

7. Department of Physical Medicine and Rehabilitation, MC Mutual, Barcelona, Spain

8. Escola Universitària Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain

9. Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland

10. Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy

Abstract

Background To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study. Methods: Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles–Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm2 and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups. Results: No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups. Conclusion: In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions. Level of Evidence: Level II, therapeutic, pilot randomized controlled trial.

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Surgery

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Foot & Ankle;Bone & Joint 360;2024-08-02

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