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Surgical Management of Freiberg's Infraction: A Systematic Review
Foot & Ankle Specialist
|May 21, 2015
Summary
Freiberg's infraction treatment outcomes show joint sparing procedures offer better symptom relief and return to activity compared to joint destructive methods. Further research is needed to optimize surgical selection.
Area of Science:
- Orthopedics
- Foot and Ankle Surgery
- Sports Medicine
Background:
- Freiberg's infraction, avascular necrosis of the second metatarsal head, has various treatment options.
- Conservative management includes medication, activity modification, and orthotics.
- Surgical intervention is considered when conservative treatments fail, but optimal procedures remain unclear.
Purpose of the Study:
- To systematically review surgical procedures for Freiberg's infraction.
- To determine which surgical approach yields the best symptom resolution and return to activity.
Main Methods:
- Systematic review of English-language, peer-reviewed studies.
- Inclusion of all patient ages with Freiberg's infraction undergoing operative treatment.
- Minimum 12-month follow-up duration.
Main Results:
- 38 of 85 identified publications met inclusion criteria.
- Joint destructive procedures (n=70) reported >70% pain resolution and return to activity (15.0-month follow-up).
- Joint sparing procedures (n=257) reported >90% pain resolution and return to activity (30.4-month follow-up).
Conclusions:
- Joint sparing procedures appear to have a better prognosis for symptom resolution and return to activity in Freiberg's infraction.
- Results favor joint sparing techniques over joint destructive procedures.
- Inconsistent reporting of Smillie stage limited analysis of its impact on procedure selection.
