Fifth metatarsal fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Tuberosity (styloid) avulsion fracture=== | ===Tuberosity (styloid) avulsion fracture=== | ||
*Most common | *Most common fracture at base of 5th metatarsal | ||
*Sx often mild, pts usually present with sprained ankle complaint | *Sx often mild, pts usually present with sprained ankle complaint | ||
*Occurs due to forced inversion foot/ankle while in plantar flexion | *Occurs due to forced inversion foot/ankle while in plantar flexion | ||
===Jones or metaphyseal-diaphyseal junction fracture=== | ===Jones or metaphyseal-diaphyseal junction fracture=== | ||
*Second most common | *Second most common fracture at base of 5th metatarsal | ||
*Abrupt onset of lateral foot pain, with no prior h/o pain at that site, suggests acute injury and helps distinguish from stress injury | *Abrupt onset of lateral foot pain, with no prior h/o pain at that site, suggests acute injury and helps distinguish from stress injury | ||
*Occurs due to sudden change in direction w/ heel off the ground | *Occurs due to sudden change in direction w/ heel off the ground | ||
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*Important to identify given propensity for delayed union and nonunion | *Important to identify given propensity for delayed union and nonunion | ||
*Usually present with h/o months of pain, which is more intense during exercise or weight-bearing | *Usually present with h/o months of pain, which is more intense during exercise or weight-bearing | ||
**always ask about persistent pain prior to acute event to help distinguish worsening stress | **always ask about persistent pain prior to acute event to help distinguish worsening stress fracture from acute fracture | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
[[File:Foot | [[File:Foot fracture.png|thumb|5th Metatarsal fracture types]] | ||
Plain radiographs are usually adequate | Plain radiographs are usually adequate | ||
*Must distinguish Jones | *Must distinguish Jones fracture from diaphyseal stress freacture: | ||
**Acute | **Acute fracture will have narrow fracture line that appears sharp, normal thin cortex adjacent to fracture, and normal intramedullary canal | ||
**Stress | **Stress fracture will demonstrate cortical thickening near fracture line, older stress fracture will demonstrate widened fracture line and intramedullary sclerosis | ||
==Management & Disposition== | ==Management & Disposition== | ||
===Tuberosity (Styloid) Avulsion Fracture=== | ===Tuberosity (Styloid) Avulsion Fracture=== | ||
*Refer to ortho if > 3mm displacement | *Refer to ortho if > 3mm displacement | ||
*Nondisplaced | *Nondisplaced fracture usually require only symptomatic tx, RICE | ||
*Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week | *Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week | ||
===Jones Fracture (non-displaced)=== | ===Jones Fracture (non-displaced)=== | ||
*[[Posterior Ankle Splint]], strict NWB, RICE, ortho f/u in 3-5 days | *[[Posterior Ankle Splint]], strict NWB, RICE, ortho f/u in 3-5 days | ||
*50% of Jones | *50% of Jones fracture treated conservatively may result in nonunion or refracture | ||
*Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing | *Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing | ||
===Diaphyseal Stress Fracture=== | ===Diaphyseal Stress Fracture=== | ||
*Strict NWB short-leg cast, RICE | *Strict NWB short-leg cast, RICE | ||
*Ortho referral for all stress | *Ortho referral for all stress fractures | ||
==See Also== | ==See Also== | ||
Revision as of 13:17, 1 April 2016
Background
- Os peroneum is an accessory bone (ossicle) located at the lateral side of the tarsal cuboid, proximal to the base of 5th metatarsal, commonly mistaken for a fracture
Clinical Features
Tuberosity (styloid) avulsion fracture
- Most common fracture at base of 5th metatarsal
- Sx often mild, pts usually present with sprained ankle complaint
- Occurs due to forced inversion foot/ankle while in plantar flexion
Jones or metaphyseal-diaphyseal junction fracture
- Second most common fracture at base of 5th metatarsal
- Abrupt onset of lateral foot pain, with no prior h/o pain at that site, suggests acute injury and helps distinguish from stress injury
- Occurs due to sudden change in direction w/ heel off the ground
- Edema & ecchymosis usually present, may not be able to bear weight
Diaphyseal stress fracture
- Occurs through repetitive microtrauma, usually in younger athletes
- Important to identify given propensity for delayed union and nonunion
- Usually present with h/o months of pain, which is more intense during exercise or weight-bearing
- always ask about persistent pain prior to acute event to help distinguish worsening stress fracture from acute fracture
Differential Diagnosis
Foot and Toe Fracture Types
Hindfoot
Midfoot
Forefoot
Diagnosis
File:Foot fracture.png
5th Metatarsal fracture types
Plain radiographs are usually adequate
- Must distinguish Jones fracture from diaphyseal stress freacture:
- Acute fracture will have narrow fracture line that appears sharp, normal thin cortex adjacent to fracture, and normal intramedullary canal
- Stress fracture will demonstrate cortical thickening near fracture line, older stress fracture will demonstrate widened fracture line and intramedullary sclerosis
Management & Disposition
Tuberosity (Styloid) Avulsion Fracture
- Refer to ortho if > 3mm displacement
- Nondisplaced fracture usually require only symptomatic tx, RICE
- Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week
Jones Fracture (non-displaced)
- Posterior Ankle Splint, strict NWB, RICE, ortho f/u in 3-5 days
- 50% of Jones fracture treated conservatively may result in nonunion or refracture
- Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing
Diaphyseal Stress Fracture
- Strict NWB short-leg cast, RICE
- Ortho referral for all stress fractures
See Also
References
Video
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