Application of nickel-titanium shape memory staples in treatment of multiple metatarsal fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Jie , YIN Zhen , ZHOU Weibo , TAN Wen ,  ZHOU Fulin

Department of Orthopedics, the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou Jiangsu, 213100, P. R. China;

Corresponding author：

ZHOU Fulin, Email: drzfulin@yeah.net

Keywords：

Metatarsal fracture; nickel-titanium memory alloy; internal fixation; soft tissue injury

DOI：

10.7507/1002-1892.202411060

Video：

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Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. Methods The clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. Results The 27 patients were followed up 9-15 months (mean, 12.3 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infections were observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. Conclusion The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.

1.	Herterich V, Hofmann L, Böcker W, et al. Acute, isolated fractures of the metatarsal bones: an epidemiologic study. Arch Orthop Trauma Surg, 2023, 143(4): 1939-1945.
2.	Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int, 2006, 27(3): 172-174.
3.	Straus SA, Henry JD, Clements JR. Metatarsal fractures. Clin Podiatr Med Surg, 2024, 41(3): 379-389.
4.	Pflüger P, Zyskowski M, Völk C, et al. Functional outcome of 111 metatarsal fractures following conservative in comparison to operative treatment. Unfallchirurg, 2022, 125(4): 288-294.
5.	Ayoglu N, Afacan MY, Ozsahin MK, et al. Match the metatarsal heads: A case of all-metatarsal fractures after a motorcycle accident. Cureus, 2023, 15(5): e39659. doi: 10.7759/cureus.39659.
6.	Mereddy PK, Molloy A, Hennessy MS. Osteochondral fracture of the fourth metatarsal head treated by open reduction and internal fixation. J Foot Ankle Surg, 2007, 46(4): 320-322.
7.	Zarei M, Bagheri N, Nili A, et al. Closed antegrade/retrograde intramedullary fixation of central metatarsal fractures: Surgical technique and clinical outcomes. Injury, 2020, 51(4): 1125-1129.
8.	陈绵, 谢广中, 梅林军, 等. 微型钢板内固定对多发跖骨骨折的愈合时间及功能影响. 实用手外科杂志, 2021, 35(1): 106-108.
9.	臧建成, 袁福禄, 刘国强, 等. 微型外固定架在足部损伤中的应用. 中国矫形外科杂志, 2010, 18(6): 524-526.
10.	McKenzie JC, Rogero RG, Khawam S, et al. Incidence and risk factors for pin site infection of exposed Kirschner wires following elective forefoot surgery. Foot Ankle Int, 2019, 40(10): 1154-1159.
11.	白继岳, 徐永清, 何晓清, 等. 镍钛形状记忆合金生物相容性及其表面改性研究进展. 中国修复重建外科杂志, 2018, 32(8): 1091-1095.
12.	章云童, 张春才, 付青格, 等. 镍钛合金记忆弓齿钉在粉碎性肩胛骨骨折治疗中的应用. 中华创伤骨科杂志, 2012, 14(7): 553-556.
13.	Ibrahim DA, Swenson A, Sassoon A, et al. Classifications In brief: The Tscherne classification of soft tissue injury. Clin Orthop Relat Res, 2017, 475(2): 560-564.
14.	Niki H, Aoki H, Inokuchi S, et al. Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders Ⅱ: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale. J Orthop Sci, 2005, 10(5): 466-474.
15.	Tornetta Ⅲ P, W Ricci, MM McQueen. 67 fractures and dislocations of the midfoot and forefoot//Thomas A, Schildhauer MFH. Rockwood and green’s fractures in adults. 9th eds. Lippincott Williams & Wilkins, 2019: 4823-4831.
16.	Sarpong NO, Swindell HW, Trupia EP, et al. Republication of “Metatarsal fractures”. Foot Ankle Orthop, 2023, 8(3): 24730114231193428. doi: 10.1177/24730114231193428.
17.	Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury, 2004, 35 Suppl 2: SB77-SB86.
18.	张春才, 许硕贵, 王家林, 等. 髋臼骨折记忆合金三维内固定系统的设计与临床应用. 中华骨科杂志, 2002, 22(12): 709-713.
19.	Liu X, Xu S, Zhang C, et al. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop, 2010, 34(7): 1033-1040.
20.	罗一林, 崔进, 谢杨, 等. 形状记忆弓齿钉与下胫腓固定螺钉治疗Maisonneuve骨折的疗效对比. 海军军医大学学报, 2023, 44(11): 1361-1365.
21.	Egrise F, Bernard E, Galliot F, et al. Treatment of two or more metatarsal fractures. Orthop Traumatol Surg Res, 2024, 110(1): 103285. doi: 10.1016/j.otsr.2022.103285.

1. Herterich V, Hofmann L, Böcker W, et al. Acute, isolated fractures of the metatarsal bones: an epidemiologic study. Arch Orthop Trauma Surg, 2023, 143(4): 1939-1945.
2. Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int, 2006, 27(3): 172-174.
3. Straus SA, Henry JD, Clements JR. Metatarsal fractures. Clin Podiatr Med Surg, 2024, 41(3): 379-389.
4. Pflüger P, Zyskowski M, Völk C, et al. Functional outcome of 111 metatarsal fractures following conservative in comparison to operative treatment. Unfallchirurg, 2022, 125(4): 288-294.
5. Ayoglu N, Afacan MY, Ozsahin MK, et al. Match the metatarsal heads: A case of all-metatarsal fractures after a motorcycle accident. Cureus, 2023, 15(5): e39659. doi: 10.7759/cureus.39659.
6. Mereddy PK, Molloy A, Hennessy MS. Osteochondral fracture of the fourth metatarsal head treated by open reduction and internal fixation. J Foot Ankle Surg, 2007, 46(4): 320-322.
7. Zarei M, Bagheri N, Nili A, et al. Closed antegrade/retrograde intramedullary fixation of central metatarsal fractures: Surgical technique and clinical outcomes. Injury, 2020, 51(4): 1125-1129.
8. 陈绵, 谢广中, 梅林军, 等. 微型钢板内固定对多发跖骨骨折的愈合时间及功能影响. 实用手外科杂志, 2021, 35(1): 106-108.
9. 臧建成, 袁福禄, 刘国强, 等. 微型外固定架在足部损伤中的应用. 中国矫形外科杂志, 2010, 18(6): 524-526.
10. McKenzie JC, Rogero RG, Khawam S, et al. Incidence and risk factors for pin site infection of exposed Kirschner wires following elective forefoot surgery. Foot Ankle Int, 2019, 40(10): 1154-1159.
11. 白继岳, 徐永清, 何晓清, 等. 镍钛形状记忆合金生物相容性及其表面改性研究进展. 中国修复重建外科杂志, 2018, 32(8): 1091-1095.
12. 章云童, 张春才, 付青格, 等. 镍钛合金记忆弓齿钉在粉碎性肩胛骨骨折治疗中的应用. 中华创伤骨科杂志, 2012, 14(7): 553-556.
13. Ibrahim DA, Swenson A, Sassoon A, et al. Classifications In brief: The Tscherne classification of soft tissue injury. Clin Orthop Relat Res, 2017, 475(2): 560-564.
14. Niki H, Aoki H, Inokuchi S, et al. Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders Ⅱ: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale. J Orthop Sci, 2005, 10(5): 466-474.
15. Tornetta Ⅲ P, W Ricci, MM McQueen. 67 fractures and dislocations of the midfoot and forefoot//Thomas A, Schildhauer MFH. Rockwood and green’s fractures in adults. 9th eds. Lippincott Williams & Wilkins, 2019: 4823-4831.
16. Sarpong NO, Swindell HW, Trupia EP, et al. Republication of “Metatarsal fractures”. Foot Ankle Orthop, 2023, 8(3): 24730114231193428. doi: 10.1177/24730114231193428.
17. Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury, 2004, 35 Suppl 2: SB77-SB86.
18. 张春才, 许硕贵, 王家林, 等. 髋臼骨折记忆合金三维内固定系统的设计与临床应用. 中华骨科杂志, 2002, 22(12): 709-713.
19. Liu X, Xu S, Zhang C, et al. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop, 2010, 34(7): 1033-1040.
20. 罗一林, 崔进, 谢杨, 等. 形状记忆弓齿钉与下胫腓固定螺钉治疗Maisonneuve骨折的疗效对比. 海军军医大学学报, 2023, 44(11): 1361-1365.
21. Egrise F, Bernard E, Galliot F, et al. Treatment of two or more metatarsal fractures. Orthop Traumatol Surg Res, 2024, 110(1): 103285. doi: 10.1016/j.otsr.2022.103285.

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