VCOM Research Day Program Book 2023

Medical Student Research Case Reports

Cody W. Smith, MS; Brett Greisemer MAEd, LAT, ATC, CSCS; Zach Maust MS, LAT, ATC; Scott Carlisle BS, LAT, ATC; John Clements DPM; Matthew Chung, DO, CAQSM Corresponding author: Csmith05@vt.vcom.edu 07 Refracture of a Previously Treated 1st Metatarsal Fracture: A Case Study on Return-to-Play Protocols and Treatment Procedures

Edward Via College of Osteopathic Medicine-Virginia Campus; VSOM

Fractures are relatively common injuries that are encountered by physicians on a regular basis. These injuries are typically treated as conservatively as possible with setting and splinting, avoiding surgical repair except for the more complicated presentations. While this practice is typically effective in the general population of patients, some populations, especially those involved in contact sports, likely require more aggressive treatment procedures. Deciding when more aggressive treatment is necessary becomes even more complicated by the fact that there is insufficient resource material for guidance regarding treatment and return to play procedures for these more unusual patients. This case follows a 17-year-old, 350 lb. male football player that first presents with a fracture of the first metatarsal as well as a subluxated second metatarsal that occurred during a game. The treating physician

followed conservative treatment procedures by re setting the subluxated metatarsal and setting and splinting the fracture. This treatment was initially successful for 3 years until the patient refractured the same metatarsal in the same location and in the same fashion (during a football game) as previously. The treating physician now opted to treat the fracture with open reduction and internal fixation (ORIF) to ensure proper bone regrowth and reconnection. This case illustrates a patient that presents with a common injury but from an uncommon patient population. While the initial treatment decisions made would have likely been sufficient in treating a fracture in the general population, this patient’s size and activity called for more aggressive treatment in order to ensure long-term successful repair. More information needs to be made readily available for

physicians in these situations in order to ensure proper treatment decisions to avoid reinjuries such as the one experienced in this case.

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