Comparison of nice knot internal fixation with Kirschner wire external fixation and tension band wiring for Lawrence zone I fractures of the fifth metatarsal base: a retrospective case-control study.

Abstract

To compare the efficacy of Nice Knot Internal Fixation with Kirschner Wire External Fixation versus conventional Tension Band Wiring for the treatment of Lawrence zone 1 fractures at the base of the fifth metatarsal bone. This study employed a retrospective case-control design, which included 37 patients with Lawrence zone I fractures of the fifth metatarsal base, treated surgically at our department from October 2023 to December 2024. Patients were divided into Group TB, receiving tension band wiring with K-wire internal fixation, and Group NK, undergoing Nice knot internal fixation combined with K-wire external fixation. Foot function was assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ-ch) and the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at 1, 2, and 3 months post-surgery. Group NK included 22 patients (11 males, 11 females; mean age: 39.50 years (range: 18-64)). Group TB comprised 15 patients (6 males, 9 females) with a mean age of 42.33 years (range: 20-62). Both groups exhibited a decline in MOXFQ-ch scores and an improvement in AOFAS midfoot scores. the 2-month postoperative follow-up, Group NK exhibited significantly superior outcomes in the pain domain of the AOFAS score compared to Group TB (p < 0.05). However, at 2 months post-surgery, the mean MOXFQ-ch score of Group NK was lower than that of Group TB (16.27 ± 6.95 < 22.19 ± 5.19, P < 0.05). The method combining Nice knot internal fixation with K-wire external fixation is a straightforward and effective approach for treating Lawrence zone I fractures of the fifth metatarsal base, yielding satisfactory clinical results.