Difference between revisions of "Fifth metatarsal fracture"

(Created page with "==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 fo...")
 
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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 fx
+
*'''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
'''3 types of 5th metatarsal fx:'''
 
#'''Tuberosity (styloid) avulsion fracture:'''
 
##Most common fx 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 fx 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 fx from acute fx
 
  
==Diagnosis==
+
==Clinical Features==
Plain radiographs are usually adequate
+
===Dancer or tuberosity (styloid) avulsion fracture===
*Must distinguish Jones fx from diaphyseal stress freacture:
+
*Most common fracture at base of 5th metatarsal
**Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
+
*Sx often mild, patients usually present with sprained ankle complaint
**Stress fx will demonstrate cortical thickening  near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
+
*Occurs due to forced inversion foot/ankle while in plantar flexion
[[File:Foot fx.png|center|frame|5th Metatarsal fx types]]
 
  
==Management==
+
===Jones or metaphyseal-diaphyseal junction fracture===
*Tuberosity (Styloid) Avulsion Fracture
+
*Second most common fracture at base of 5th metatarsal
**Refer to ortho if > 3mm displacement
+
*Abrupt onset of lateral foot pain, with no prior history of pain at that site, suggests acute injury and helps distinguish from stress injury
**Nondisplaced fx usually require only symptomatic tx, RICE
+
*Occurs due to sudden change in direction with heel off the ground
**Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week
+
*Edema & ecchymosis usually present, may not be able to bear weight
*Jones Fracture (non-displaced)
+
 
**Posterior splinting, strict NWB, RICE, ortho f/u in 3-5 days
+
===Diaphyseal stress fracture===
**50% of Jones fx treated conservatively may result in nonunion or refracture
+
*Occurs through repetitive microtrauma, usually in younger athletes
**Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing
+
*Important to identify given propensity for delayed union and nonunion
*Diaphyseal Stress Fracture
+
*Usually present with history of months of pain, which is more intense during exercise or weight-bearing
**Strict NWB short-leg cast, RICE
+
**always ask about persistent pain prior to acute event to help distinguish worsening stress fracture from acute fracture
**Ortho referral for all stress fxs
+
 
 +
==Differential Diagnosis==
 +
{{Foot and toe fractures DDX}}
 +
 
 +
==Evaluation==
 +
===Workup===
 +
*Plain radiographs are usually adequate
 +
 
 +
===Diagnosis===
 +
[[File:Foot fx.png|thumb|5th Metatarsal fracture types]]
 +
[[File:PMC3497949 10.1177 1941738112459489-fig14.png|thumb|Fractures of the fifth metatarsal base. Frontal radiograph (A) demonstrates fifth metatarsal base fractures based on location. Frontal radiograph (B) in a 24-year-old runner following inversion injury demonstrates an avulsion fracture of the fifth metatarsal base. Oblique radiograph (C) in an 11-year-old boy demonstrates an unfused fifth metatarsal base apophysis, a common fracture mimic.]]
 +
[[File:PMC4512960 12245 2015 76 Fig6 HTML.png|thumb|Jones fracture. Transverse fracture 2 cm from the base of the fifth metatarsal]]
 +
*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 (Dancer’s or pseudo-Jones fracture)===
 +
''Proximal to the more diaphyseal Jones 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==
Line 41: Line 59:
 
*[[Foot Diagnoses (Main)]]
 
*[[Foot Diagnoses (Main)]]
  
==Source==
+
==References==
*Tintinalli
 
*Uptodate
 
 
*http://radiopaedia.org/articles/jones_fracture
 
*http://radiopaedia.org/articles/jones_fracture
  
[[Category:Ortho]]
+
==Video==
 +
{{#widget:YouTube|id=4k1dvPdpW4E}}
 +
 
 +
[[Category:Orthopedics]]

Revision as of 04:41, 26 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 Fractures

Hindfoot

Midfoot

Forefoot

Evaluation

Workup

  • Plain radiographs are usually adequate

Diagnosis

5th Metatarsal fracture types
Fractures of the fifth metatarsal base. Frontal radiograph (A) demonstrates fifth metatarsal base fractures based on location. Frontal radiograph (B) in a 24-year-old runner following inversion injury demonstrates an avulsion fracture of the fifth metatarsal base. Oblique radiograph (C) in an 11-year-old boy demonstrates an unfused fifth metatarsal base apophysis, a common fracture mimic.
Jones fracture. Transverse fracture 2 cm from the base of the fifth metatarsal
  • 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 (Dancer’s or pseudo-Jones fracture)

Proximal to the more diaphyseal Jones 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