Difference between revisions of "Fifth metatarsal fracture"

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==Clinical Features==
 
==Clinical Features==
 
===Tuberosity (styloid) avulsion fracture===
 
===Tuberosity (styloid) avulsion fracture===
*Most common fx at base of 5th metatarsal
+
*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 fx at base of 5th metatarsal
+
*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 fx from acute fx
+
**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 fx.png|thumb|5th Metatarsal fx types]]
+
[[File:Foot fracture.png|thumb|5th Metatarsal fracture types]]
 
Plain radiographs are usually adequate
 
Plain radiographs are usually adequate
*Must distinguish Jones fx from diaphyseal stress freacture:
+
*Must distinguish Jones fracture from diaphyseal stress freacture:
**Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
+
**Acute fracture will have narrow fracture line that appears sharp, normal thin cortex adjacent to fracture, and normal intramedullary canal
**Stress fx will demonstrate cortical thickening  near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
+
**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 fx usually require only symptomatic tx, RICE
+
*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 fx treated conservatively may result in nonunion or refracture
+
*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 fxs
+
*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 Fractures

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