Fifth metatarsal fracture: Difference between revisions
(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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**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 | **[[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 fx 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 |
Revision as of 04:48, 4 January 2014
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
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
Plain radiographs are usually adequate
- Must distinguish Jones fx from diaphyseal stress freacture:
- Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
- Stress fx will demonstrate cortical thickening near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
Management
- Tuberosity (Styloid) Avulsion Fracture
- Refer to ortho if > 3mm displacement
- Nondisplaced fx 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 fx 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 fxs
See Also
Source
- Tintinalli
- Uptodate
- http://radiopaedia.org/articles/jones_fracture