Surgical treatment of lesser metatarsal stress fractures with a combination of injectable calcium phosphate and bone marrow aspirate

The treatment of metatarsal stress fractures typically involves a period of immobilization and offloading to allow bone to remodel. For those resistant to conservative therapy, surgical treatment options are limited. The purpose of this study is to investigate the efficacy of an injection of calcium phosphate and bone marrow aspirate for treatment of metatarsal stress fractures. A retrospective chart review was performed over a 5-year period. Four patients with lesser metatarsal stress fractures resistant to conservative therapy had undergone a percutaneous injection of a calcium phosphate and bone marrow aspirate. The Visual Analog Scale scores for pain at the pre-operative, 5-day, 2-week, 4-week, 8-week, 3-month and 6-month post-operative visits were evaluated for mean improvement. Additionally, a radiographic review was performed to evaluate any adverse outcomes or failure of fixation. A mean Visual Analog Scale pain score of 7.5 ± 1.5 was obtained from patients prior to operation and decreased to a mean 1 ± 1.15 at the 6-month follow-up. There was a progressive improvement at each follow-up with statistical significance (p ≤ 0.05) at each time point. Patients were weight bearing as tolerated post-operatively in protective device with return to a supportive sneaker at a mean 4 weeks. This study shows excellent results with the injectable calcium phosphate and bone marrow aspirate combination for treatment of lesser metatarsal stress fractures. Although current literature is limited in surgical treatment of these insufficiency fractures, this novel technique supports the consideration of this modality for use in clinical practice.