Fifth metatarsal fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
=== | ===Dancer or tuberosity (styloid) avulsion fracture=== | ||
*Most common fracture at base of 5th metatarsal | *Most common fracture at base of 5th metatarsal | ||
*Sx often mild, patients usually present with sprained ankle complaint | *Sx often mild, patients usually present with sprained ankle complaint | ||
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===Jones or metaphyseal-diaphyseal junction fracture=== | ===Jones or metaphyseal-diaphyseal junction fracture=== | ||
*Second most common fracture at base of 5th metatarsal | *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 with heel off the ground | *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 fracture from acute fracture | **always ask about persistent pain prior to acute event to help distinguish worsening stress fracture from acute fracture | ||
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{{Foot and toe fractures DDX}} | {{Foot and toe fractures DDX}} | ||
==Diagnosis== | ==Evaluation== | ||
[[File:Foot | ===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: | *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 | **Acute fracture will have narrow fracture line that appears sharp, normal thin cortex adjacent to fracture, and normal intramedullary canal | ||
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==Management & Disposition== | ==Management & Disposition== | ||
===Tuberosity (Styloid) Avulsion Fracture=== | {{General Fracture Management}} | ||
===Tuberosity (Styloid) Avulsion Fracture (Dancer’s or pseudo-Jones fracture)=== | |||
''Proximal to the more diaphyseal Jones fracture'' | |||
*Refer to ortho if > 3mm displacement | *Refer to ortho if > 3mm displacement | ||
*Nondisplaced fracture usually require only symptomatic | *Nondisplaced fracture usually require only symptomatic treatment, RICE | ||
*Walking boot (casting rarely necessary) and weight-bearing as tolerated, follow up in 1 week | *Walking boot (casting rarely necessary) and weight-bearing as tolerated, follow up in 1 week | ||
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*Strict NWB short-leg cast, RICE | *Strict NWB short-leg cast, RICE | ||
*Ortho referral for all stress fractures | *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 05:17, 18 September 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
Workup
- Plain radiographs are usually adequate
Diagnosis
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.
- 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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
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
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