In addition to the fractures, the soft tissues usually are damaged considerably and swelling may be excessive. Displaced fractures usually are produced by severe trauma. Because of their strong interosseous ligaments, fractures of the proximal metatarsals usually do not become displaced significantly. Perhaps this is because they usually heal uneventfully and rarely need operative treatment. Azar MD, in Campbell's Operative Orthopaedics, 2021 Metatarsal and Phalangeal FracturesĪlthough metatarsal and phalangeal fractures in children are common, little has been written about these fractures. In most cases, these fractures can be managed without casting merely eliminating impact (e.g., running, jumping) until clinical healing is documented is sufficient.įrederick M. Symptoms may precede radiographic findings by 2 to 3 weeks. Stress fractures of the other metatarsal shafts are much more common and usually less severe. With intramedullary screw fixation, the athlete may return to his or her sport much earlier. Some experts recommend orthopedic consultation in every case because optimal conditions may require up to 20 weeks of immobilization and nonunion may still occur. MRI has somewhat replaced bone scan for detecting early stress fractures because of increased sensitivity and specificity it should be noted that specificity of MRI is not perfect, so clinical correlation is also important. This fracture is also notoriously slow to heal. This possible prolonged healing and delay in return to sport may cause some patients to request screw fixation, especially athletes.Ī stress fracture of the fifth metatarsal can be confused with a Jones fracture, but it typically occurs in the proximal shaft. No impact sports should be allowed after this injury for a minimum of 3 months. This fracture is notorious for delayed union, especially in patients who smoke or take antiinflammatory medications. At this point, if neither clinical nor radiographic healing is apparent, a non–weight-bearing cast should be reapplied for 4 more weeks or the patient referred. If it appears acute and nondisplaced, it will usually heal well with a short-leg walking cast for 6 to 8 weeks and no weight bearing for the first 3 weeks. If there are signs of stress fracture (e.g., widened fracture line, medullary sclerosis), referral should be considered to avoid prolonged immobilization or nonunion. If the fracture is displaced, the patient should be referred to an orthopedic surgeon. A Jones fracture occurs in nearly the same location however, it extends (if not initially, eventually) across the entire shaft just distal to the base of the fifth metatarsal and into the joint between the bases of the fourth and fifth metatarsals. However, impact sports should be avoided for a minimum of 2 months.Ī metatarsal avulsion fracture must be differentiated from a Jones fracture, which is much less common and treated entirely differently. The wooden-soled shoe is worn for 3 weeks or longer until the patient is comfortable without it and can return to wearing a regular shoe. The purpose of the wooden-soled shoe or cast is to prevent flexion at the midfoot when the patient walks, thereby preventing stress at the fracture site. If the patient continues to experience significant discomfort at the first follow-up visit in 4 to 7 days, a short-leg walking cast (limited to 2 weeks) may help to reduce symptoms. The displacement is usually no greater than 3 mm it is treated with a firm or wooden-soled fracture shoe with weight bearing as tolerated and ice and elevation for comfort. With an inversion sprain-type injury to the forefoot and ankle, a small piece of bone can be pulled loose. The most common metatarsal fracture is at the base of the proximal fifth metatarsal and represents an avulsion fracture of the styloid where the peroneus brevis tendon and plantar aponeurosis insert. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020 Metatarsal Fractures
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |