Fracture of the 5th metatarsal

A fracture of the metatarsal can result from traumatic and pathological causes.

fracture of the metatarsal bone

A metatarsal fracture is a traumatic injury to the metatarsal bone that causes the bone to shift or deform. A metatarsal injury is found in one in four patients with a foot injury. The symptomatology of the injury is so pronounced that patients immediately go to the clinic for treatment.

The tarsal bones are among the smallest bones in the musculoskeletal system. The foot is made up of twenty-six bones in all, which together form a vast network of interconnected bones. Five bones make up the metatarsal bones. They are located between the tarsal bone and the phalanges of the toes. A fracture can occur anywhere, but the fifth bone is most commonly affected.

Since the foot performs extremely important functions and is subjected to active physical exertion on a daily basis, it is not surprising that metatarsal fractures are so common. A fracture of the fifth metatarsal, for example, can result from frequent subluxation of the foot.

classification of injuries

There are several types of metatarsal fractures. A traumatic fracture is usually caused by a fall onto the foot from a height, an injury to the foot, or a blow to the foot. Patients of young, working age, in their 20s to 40s, are usually at risk.

Another category of fracture is the stress fracture. This injury results from prolonged stress on the foot and frequent trauma to the foot. People whose work involves a lot of physical activity are generally at risk. These include ballerinas, gymnasts, soccer players and dancers.

A fracture of the marcher's bone also occurs in Deutschlander's disease—this injury, as a rule, occurs in the military and is named for the doctor who first identified the pathology. This injury damages the bone at the base of the metatarsal. Both male and female athletes are at risk.

Depending on the type of fracture, stress injuries are divided into fractures with and without displacement. Fractures can also be spiral, oblique, or transverse. A comminuted fracture is diagnosed when a heavy object has fallen on the leg, severely crushing the bone.

A comminuted Jones fracture is a severe fracture in which the bone at the base of the fifth metatarsal becomes traumatic and these injuries almost never heal due to the large number of fragments. A burst foot fracture occurs when a fragment of bone becomes detached when the tendon is pulled too hard.

IMPORTANT!!! This type of injury can be difficult to diagnose because the symptoms of a sprain are the most painful for the patient and can be misdiagnosed.

An avulsion fracture is a transverse fracture injury in which the bones do not move relative to each other. This injury is caused by a twisted tendon and is also difficult to diagnose from the outside. For this reason, it is important to recognize not only the complications of the injury, but also the injury itself. Otherwise, irreversible processes can occur and the injury will not heal.

signs

The formation of a false joint takes a lot of time. Patients attribute the discomfort and pain they feel at the fracture site to the healing process of the bone or other external factors (even down to the body's reaction to weather changes). Therefore, they do not even realize that they are suffering from pseudarthrosis and unhealed fractures. In fact, one characteristic symptom can already indicate the presence of a pathology: increased mobility of the limbs in areas where anatomy would rule out the presence of a pathology. In later stages, other symptoms appear:

• the ability to twist unnaturally;
• increasing the range of motion of the joints;
• limb shortening;
• decrease in muscle strength;
• Impaired motor function of the affected limb;
• pain on exertion.

Twisting of the legs may occur when walking and the use of crutches may be required. Decreased pressure on the true joints can also lead to joint dysfunction. Significant swelling can often be observed in the area of the false joint, which is due to active connective tissue growth.

Causes of an incorrect joint and healed fractures

A wrong joint is a complication of an unhealed fracture. Its formation is directly related to the disruption of the fusion of bone fragments, which can be caused by the following causes.

• soft tissues surrounding the bone fragments;
• wide spread of broken bone elements;
• insufficient immobilization of the injured limb;
• problems with the blood supply to the bone;
• abscess formation at the fracture site.

A high risk of pathology is associated with fractures with multiple breaks, wound infection and improper application of a plaster cast to the injured limb. Those most at risk are those who have:

The space between the individual bone fragments gradually fills with connective tissue. Their edges fuse with the cartilage, which increases the mobility of the injured limb. At the same time, a pseudo-articular cavity is formed in the gap. This is filled with liquid and coated.

Which doctor should I see?

If there is unnatural mobility at the fracture site and overall mobility of the limb is compromised, the bone probably has not healed. If this is the case, you should consult a doctor immediately. Treats false joints and unhealed fractures:

Fractures of the 5th metatarsal.

MD, University of California, San Francisco

Fractures of the 5th metatarsal can occur at the base of the metatarsal or on the body (diaphysis). Diaphyseal fractures can be acute fractures or stress fractures. Because the treatment and prognosis of these fractures vary widely, accurate diagnosis is important. The diagnosis is made radiologically. Treatment depends on the location of the fracture.

Pain, swelling, and tenderness on palpation are usually found at the exact point of the fracture.

Diagnosis of a fracture of the 5th metatarsal is based on radiographs of the foot in the anteroposterior, lateral, and oblique planes.

Fractures of the base of the 5th metatarsal

Fractures of the base of this bone are sometimes referred to as dancer's fractures or pseudo-fractures of the humerus. Their mechanism is usually related to a crush injury or a tangential force pulling the tendon away from the fibula muscle. These fractures are more common than acute diaphyseal fractures (Jones fractures).

Since the pedicle, in contrast to the diaphysis, is supplied with plenty of peripheral blood, delays in healing and healing disorders are rare.

Treatment

Management of 5th metatarsal fractures is symptomatic and may include wearing rigid-soled shoes or an orthotic and carrying weight as tolerated.

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fracture of the metatarsal bone

The metatarsals are a group of 5 long bones located in the metatarsus. They connect the back of the foot to the toes. A metatarsal fracture is a fracture of one of these bones. When a bone is broken, it is called a fracture. For more information, see General Information About Bone Fractures. General information about broken bones When a bone is broken, it is called a fracture. It doesn't matter whether it's a small fracture or a severe break with lots of bone splinters. Broken bones are very painful and cause swelling. broken. Read more

Doctors diagnose stress fractures using X-rays An X-ray is an imaging test that takes a picture of the body's internal structures. It uses a small dose of X-rays. Read more (Although it sometimes takes several weeks to show up on X-rays), a CT scan A CT scan uses a large, bag-shaped machine that can take X-ray pictures from multiple angles. The X-ray pictures are then processed by a computer. Read more or MRI Magnetic resonance imaging (MRI) is a test that uses a machine with a powerful magnet to take pictures of the body's internal structures. The computer records changes in the magnetic field around the body. Read more .

What is a stress fracture?

Stress fractures are small broken bones caused by repeated stress.

Jones fracture

Jones' fracture is the most unfortunate fracture of the fifth metatarsal as it is very difficult to heal. It occurs near the back of the bone at an anatomical site called the metaphyseal-diasea junction.

It is believed that this area of bone has less blood flow than other bones, so it is slow to heal. This is especially true if the hernia further impedes blood flow.

Jones fractures can be treated with or without surgery, although most surgeons recommend surgery if you are physically active, especially athletes. During surgery, a single screw is usually inserted into the bone canal to stabilize it.

If a Jones fracture is treated without surgery, a cast is required for six to 12 weeks.

avulsion fractures

An avulsion fracture is by far the most common fracture of the fifth metatarsal. It occurs in the posterior part of the bone closest to the ankle. It is commonly confused with a Jones fracture and is often referred to as a pseudo-Jones fracture.

Avulsion fractures are so named because a small piece of bone attached to a tendon or ligament has become detached from the underlying portion of bone (avulsion). This can affect part of the bone or break the bone completely into segments.

Injuries that result in avulsion fractures of the fifth metatarsal are usually severe and can break the bone into many small pieces.

Most fifth metatarsal avulsion fractures do not require surgery. More often they are treated with protective restraint, e.g. B. treated with a fracture shoe.

Surgery may be necessary if the bones are improperly separated, angled, or misaligned.

frequently asked Questions

It depends on. Some people can still put weight on their foot after a metatarsal fracture. Just because they can walk doesn't necessarily mean the foot isn't broken. However, putting weight on the broken foot is usually very painful and is not recommended.

A fracture of the fifth metatarsal is usually treated with immobilization in a walking or shoe cast. Some fractures may require surgery. A break near the toe, for example, often requires surgery to realign the bone. In this case, the surgeon usually waits a week to see if the bone is healing properly and is stable before surgically restoring the bone.

A simple metatarsal fracture usually heals after six to eight weeks of immobilization. It's likely that after a few days or a week you'll be able to bear weight in a cast. Once the cast is off, it may be about a month before you can exercise and exercise again. If the fracture requires surgery, it may take longer to heal. You may not be able to put weight on your broken foot for up to six weeks. Physiotherapy may be required to restore full functionality.

In the case of a broken foot, treatment can take up to six weeks.

Correct and timely rehabilitation after a fracture of the 5th metatarsal can restore the full function of the foot and avoid the development of serious pathologies in the future. Often such an injury leads to:

1. re-fractures around the resulting bony callus;
2. disruption of microcirculation in the area of the injury and scarring of the surrounding soft tissues;
3. Deposition of calcium salts in the tendon fibers, leading to the development of crepitating tendinitis;
4. development of plantar fasciitis and heel spurs;
5. development of arthrosis in the small bone joints;
6. the development of a flat foot or clubfoot (depending on the location of the fracture).

Comprehensive rehabilitation after a fracture of the 5th metatarsal avoids all of these consequences and restores normal foot function. Rehabilitation is best done under the guidance of an experienced podiatrist. It will also help rule out any abnormalities in the alignment of the foot that may have caused the metatarsal fracture.

Rehabilitation of a fracture of the 5th metatarsal begins as soon as the plaster cast is removed and radiographic evidence shows that the damaged tissue has completely healed. The course is designed individually. In our chiropractic clinic, the following techniques are used to recover from a fracture of the 5th metatarsal

• Therapeutic gymnastics – restores tension in muscles, tendons and ligaments, improves blood circulation and accelerates the process of diffuse nutrition of cartilage and connective tissue;
• Osteopathy – improves the process of blood and lymph microcirculation;
• Massage – increases the elasticity of soft tissues, relieves excessive tension;
• Physical therapy – stimulates tissue regeneration processes;
• Reflexotherapy – activates the natural process of tissue regeneration.

prevention

A metatarsal fracture can be prevented by following simple rules:

• Eat a healthy diet and lead an active lifestyle;
• Watch your weight and avoid being overweight;
• Wear comfortable shoes with a heel of no more than 4 cm;
• Do physical exercises to strengthen ligaments and muscles;
• To swim.

If a fracture is suspected, you should not try to treat the injury yourself, but consult a doctor immediately.

Classification of fractures of the base of the 5th metatarsal.

tuberous fracture. A burst fracture caused by a longitudinal ligament that is too long, a lateral bundle of the longitudinal fascia, or acute hyperextension of the eye muscles. Fractures without fusion are rare.

Metaphyseal-diasea transition zone. Transitions to the tarsometatarsal joint. Poorly perfused. High risk of non-adhesion.

Fracture of the proximal part of the diaphysis. Located distal to the intertarsal joint. Stress fracture in runners. Associated with cavovarus deformity and sensory neuropathies. High risk of non-healing.

Symptoms of a fracture of the base of the 5th metatarsal.

Pain on the outer edge of the foot that increases with exertion. On palpation: standard pain, crepitations, and mobility, although the latter two symptoms may be absent if the fracture is incomplete or without displacement. The pain increases with eversion of the foot. Instrumental diagnosis is by direct, lateral, and oblique radiographs, and rarely by CT or MRI.

Zone 1 fractures are usually treated conservatively. Immediately after the injury, a cast or rigid orthosis is applied to allow walking with full weight bearing. Immobilization is carried out for 3 weeks, after which special shoes with a rigid sole are recommended. Some stress-related pain persists for up to 6 months.

Second and third zone fractures without dislocation require longer immobilization: 6-8 weeks. The load on the legs (walking on crutches) should be completely stopped. If x-rays show signs of healing, rigid-soled shoes can be worn.

Due to the high risk of non-healing fractures in zones 2 and 3, surgical treatment is recommended. This is because 25 % of acute fractures and 50 % of chronic fractures (with significant periosteal reaction and intramedullary sclerosis) in zones 2 and 3 will not heal with cast immobilization. Intramedullary internal fixation with a compression screw is the most common surgical treatment for fractures in zones 2 and 3. Large diameter screws (6-6.5 mm) are desirable to ensure adequate compression and avoid rotational instability. Two different techniques are used: in one, the screw is inserted closely along the intramedullary canal, and the canal must be carefully drilled and palpated beforehand to avoid diaphyseal fracture during screw insertion. Long screws must not be used, as a fracture of the diaphyseal canal wall can occur in the narrower part of the neck of the bone. The second technique is to insert the screw perpendicular to the fracture plane, exiting through the anteromedial cortical plate of the diaphysis. The canal must also be drilled and palpated.

Treatment of an unresectable fracture

The aim of treating unresectable fractures is to restore limb function. The main goals are complete consolidation, elimination of deformity, elimination of joint stiffness and sanitation of infectious lesions. In the presence of common triggers (endocrine disorders, avitaminosis, etc.), appropriate general therapeutic measures are taken. The local treatment program is adapted to the type of unresectable fracture.

Treatment of delayed consolidation

Conservative treatment is possible. Immobilization of the limb in a cast or orthosis for the time it takes for the fracture to heal is used. Shock wave therapy, UHF, calcium salt electrophoresis and electromagnetic waves are used to promote consolidation. Anabolic steroids are used. A bone and cartilage extract made from embryonic tissue is injected into the unhealed fracture.

The advantages of conservative treatment are that there is no additional trauma, no anesthesia and no postoperative risk. The downside is prolonged immobilization, which can lead to joint stiffness and limb atrophy. To prevent these complications or when conservative measures are ineffective, surgical treatment is performed. The following options are possible:

• osteosynthesis. It is performed with screws, compression plates, intramedullary pins, and external fixation devices. It is indicated when anastomotic elements are present, there is no obvious displacement, and the limb axis is disturbed.
• bone graft. Autologous bone grafts are used, which are usually taken from the patient's hip bone wing. The displaced molar bone promotes the transformation of the surrounding callus into normal bone tissue.
• stimulation of osteogenesis. This is done through biological decortication and tunneling techniques. During decortication, a pointed osteotome is used to create an acetabular cup around the fracture, which is formed from a multitude of bone fragments connected to the periosteum. Tunneling involves creating tunnels to encourage bone formation.

forecast

The prognosis depends largely on the type of non-healable fracture. The earlier treatment is started, the easier it is to achieve good consolidation. In the long term, restoration of bone integrity is possible, but requires long-term treatment and subsequent rehabilitation. The result can be good functional outcomes, persistent joint stiffness, residual limb dysfunction with atrophy.

Prevention of non-fused fractures includes early appropriate reduction, avoidance of interposition, avoidance of removal of viable bone fragments, timely surgical intervention for ineffective reduction, observance of periods of immobilization, and gradual increase in limb loads based on clinical and radiological evidence signs of healing.

Complications in the treatment of fractures (delayed and unhealed fractures, incorrect joints). Textbook / Malanin DA et al – 2007.

2. Treatment of patients with complications and sequelae of fractures of long limbs. Summary of the dissertation / Eldzarov PE – 2015.

4. Method of predicting disorders of bone tissue regeneration in fractures of long limbs in the postoperative period/ Miranov AM, Uskov SA // Genius of Orthopedics – 2011 – № 4.

• tarsal bones of the foot.
• Cracked metatarsal.
• Bruising of the metatarsal in the foot.
• Fracture of the lateral condyle.
• Closed fracture of the ankle.
• Fracture of the calcaneus of the foot.
• metatarsal bones.
• Fracture of the heel bone.