Fifth metatarsal fracture: Difference between revisions
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==Background== | ==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 | *'''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== | ==Clinical Features== | ||
=== | ===Dancer or tuberosity (styloid) avulsion fracture=== | ||
*Most common | *Most common fracture at base of 5th metatarsal | ||
*Sx often mild, | *Sx often mild, patients 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 | *Abrupt onset of lateral foot pain, with no prior history of pain at that site, suggests acute injury and helps distinguish from stress injury | ||
*Occurs due to sudden change in direction | *Occurs due to sudden change in direction with heel off the ground | ||
*Edema & ecchymosis usually present, may not be able to bear weight | *Edema & ecchymosis usually present, may not be able to bear weight | ||
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*Occurs through repetitive microtrauma, usually in younger athletes | *Occurs through repetitive microtrauma, usually in younger athletes | ||
*Important to identify given propensity for delayed union and nonunion | *Important to identify given propensity for delayed union and nonunion | ||
*Usually present with | *Usually present with history of 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== | ||
{{Foot and toe fractures DDX}} | {{Foot and toe fractures DDX}} | ||
==Evaluation== | |||
[[File:Foot fx.png|thumb|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 treatment, RICE | |||
*Walking boot (casting rarely necessary) and weight-bearing as tolerated, follow up in 1 week | |||
===Jones Fracture (non-displaced)=== | |||
*[[Posterior Ankle Splint]], strict NWB, RICE, ortho follow up in 3-5 days | |||
*50% of Jones fracture treated conservatively may result in nonunion or re-fracture | |||
*Conservative treatment 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 | |||
* | |||
* | |||
== | ===Traumatic Diaphyseal Fracture=== | ||
*[[Posterior Ankle Splint]], NWB, RICE, ortho/podiatry follow up in 3-5 days | |||
*Dorsal or Plantar displacement >10% or 3-4mm may require reduction in ED or at referral clinic while lateral/medial displacement usually heal well without reduction | |||
* | |||
==See Also== | ==See Also== | ||
Revision as of 19:18, 12 February 2019
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
Dancer or tuberosity (styloid) avulsion fracture
- Most common fracture at base of 5th metatarsal
- Sx often mild, patients 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 history of pain at that site, suggests acute injury and helps distinguish from stress injury
- Occurs due to sudden change in direction with 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 history of 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
Evaluation
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 treatment, RICE
- Walking boot (casting rarely necessary) and weight-bearing as tolerated, follow up in 1 week
Jones Fracture (non-displaced)
- Posterior Ankle Splint, strict NWB, RICE, ortho follow up in 3-5 days
- 50% of Jones fracture treated conservatively may result in nonunion or re-fracture
- Conservative treatment 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
Traumatic Diaphyseal Fracture
- Posterior Ankle Splint, NWB, RICE, ortho/podiatry follow up in 3-5 days
- Dorsal or Plantar displacement >10% or 3-4mm may require reduction in ED or at referral clinic while lateral/medial displacement usually heal well without reduction
See Also
References
Video
{{#widget:YouTube|id=4k1dvPdpW4E}}