Background: An avulsion fracture of the proximal fifth metatarsal may result in a symptomatic nonunion and hinder athletic performance. Nonoperative management is often successful in alleviating symptoms. When symptoms persist, surgery can be undertaken to repair the nonunion or excise the avulsed fragment.
Purpose: The excision of the avulsed bone fragment is evaluated in the management of symptomatic nonunions.
Study Design: Case series; Level of evidence, 4.
Methods: Excision of the avulsed fifth metatarsal fragment was performed in 6 male high-performance athletes with symptomatic nonunions. The remaining edge of bone was contoured and smoothed.
Results: All 6 patients experienced an uneventful operation and recovery, returning to competitive play at a mean of 11.7 weeks. Activity-related pain and discomfort abated after the excision and rehabilitation. No surgical complications were noted.
Conclusion: Surgical excision of the avulsed fragment from the proximal fifth metatarsal is a safe and effective alternative intervention when nonoperative methods fail.
Background: Pain in the buttock radiating to the popliteal fossa associated with hamstring weakness can be caused by tethering of the sciatic nerve to the proximal hamstring tendons. Contraction of the hamstring muscles produces traction on the sciatic nerve and subsequent symptoms.
Hypothesis: Surgical release of the proximal hamstring tendons, in particular from the sciatic nerve, will improve symptoms and function.
Study Design: Case series; Level of evidence, 4.
Methods: Forty-seven proximal hamstring surgical releases were performed in 44 patients (28 males, 16 females). The initial clinical findings and imaging were obtained from the medical notes, and additional data were obtained from a later questionnaire. The average age at the time of surgery was 29 years (range, 15–58 years). All patients were involved in high-level sports. Long-term follow-up was with a comprehensive postal questionnaire.
Results: Full follow-up was obtained in 43 patients (46 operations). Average follow-up was 53 months (range, 9–110). No major complications were encountered from the surgery. The average visual analog scale pain score decreased from 6.5 preoperatively to 2.0 (P < .001). Two patients had increased pain, and pain was unchanged in 4. The average subjective weakness score decreased from 6.6 to 2.8 (P < .001). Three patients reported increased weakness at follow-up, and 3 patients reported that the hamstring muscles felt equally weak. Thirty-four patients (77%) had returned to their previous sporting activities, with 30 patients still competing at or above state level, or professionally, after surgery. The average satisfaction score was 7.8. Six patients (14%) were not satisfied with the outcome of the procedure, 5 patients (11%) were somewhat satisfied, and 33 patients (75%) were very satisfied.
Conclusion: Proximal hamstring syndrome occurs mainly in patients participating in competitive sports. Release of the proximal hamstring tendons in this active group resulted in decreased pain and increased strength, and the majority of patients were satisfied with the procedure.
