Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Metatarsal Fracture

From WikiSM
(Redirected from Distal metatarsal fracture)


Other Names

  • Met Fracture
  • Metatarsal Fracture
  • Metatarsal stress fracture
  • 1st metatarsal fracture
  • Central metatarsal fracture (CMF)

Background

History

Epidemiology

  • Prevalence
    • Represent about 88% of all fractures involving the foot and ankle[1]
    • Represent 35% of all foot fractures[2]
    • 5% - 7% of musculoskeletal injuries[3]
    • 1.2% are open fractures
  • Incidence
    • Approximately 6.7 per 10,000 people[4]
  • Demographics
    • Among non athletes, the average age is 42 and female
    • Among athletes, the average age is 26 and male
  • Pediatric considerations[5]
    • Under 5: 1st metatarsal is most commonly fractured
    • Over 5: 5th metatarsal is most commonly fractured
    • Account for 61% of all fractures of the foot[6]

Pathophysiology

  • General
    • Occur as a result of direct trauma to forefoot
    • Central metatarsals include the 2nd, 3rd, and 4th

Etiology

  • Generally occur due to low energy trauma
  • Fall from standing height
  • Twisting injury with a static forefoot

Fracture Patterns

  • Location
    • 5th metatarsal is most common, followed by 3rd metatarsal[7]
    • Contiguous metatarsal fractures occur in 9% of all metatarsal fractures
    • 60% of middle metatarsal fractures associated with neighboring metatarsal injury[4]
    • 1st metatarsal fractures are the least common, representing only 1.5% of metatarsal fractures

Associated Conditions

Pathaoanatomy

  • Metatarsal Bones
    • Skeletal component of the foot between the tarsus and the foot phalanges
    • Numbered 1 to 5 from medial to lateral

Risk Factors

  • Unknown

Differential Diagnosis

Clinical Features

  • History
    • Characterized by pain, swelling and trouble weight bearing
    • Deformities are typically absent unless there are more significant injuries present
  • Physical Exam: Physical Exam Foot
    • Bruising and swelling
    • Tenderness to metatarsal
    • Pain with axial loading of the forefoot
  • Special Tests

Evaluation

Radiographs

MRI

  • Only recommended for occupt fractures, or suspected stress fracture

CT

  • Useful to
    • Assess the degree of intra-articular involvement, comminution
    • Evaluate integrity of lisfranc joint
    • Surgical planning when appropriate

Classification

AO-ICI (Integral classification of injuries)

  • Type A: extra-articular fractures[8]
    • Subdivided into metaphyseal, diaphyseal, and distal metaphyseal fractures
  • Type B: intra-articular fracture
    • subdivided into proximal partial articular, meta-diaphyseal wedge, and distal partial articular
  • Type C: fracture-dislocations
    • subdivided into proximal complete articular, meta-diaphyseal communition, and distal complete articular
  • Type D: pure metatarsal dislocation or ‘floating metatarsal.’

Management

  • Objectives
    • Restore the alignment of all metatarsals
    • Maintain the arches of the forefoot
    • Normal distribution of weight under the head of metatarsals

Nonoperative

1st Metatarsal

  • Indications
    • Nondisplaced, stable fractures
    • Isolated avulsion fractures
  • Serial radiographs
    • close radiographic monitoring for callous formation
  • Immobilization/ Protection
  • Weightbearing status
    • Non-weight bearing for at least 3 weeks
    • Progression to a walking cast for another 3 weeks

Central Metatarsals

  • Indications
    • Nondisplaced or minimally displaced
    • Nondisplaced or minimally displaced neck fractures
    • Less than 10° sagittal angulation, 3 - 4 mm displacement in any plane
  • Immobilization/ Protection
  • Weight bearing status
    • Weight bearing as tolerated

Operative

1st Metatarsal

  • Indications
    • Unstable closed fractures
    • Intra-articular fracture
    • Open fractures
    • Polytrauma
  • Technique
    • Open reduction, internal fixation
    • K-wire fixation
    • Plate osteosynthesis
    • Reconstruction of the TMTJ, MTPJ

Central Metatarsals

  • Indications
    • Displacement > 2 mm
    • More than 10° sagittal angulation, 3 - 4 mm displacement in any plane
    • Displaced metatarsal neck fractures
  • Technique
    • K-wire fixation

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Patient predictors of poor outcome[10]
  • Injury predictors of poor outcome
    • Open fractures[11]
    • Planatarly displaced fracture

Complications

See Also

References

  1. ↑ Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, De Vries MR, Van Der Elst M, Schepers T. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg. 2011;131:241–5.
  2. ↑ Vuori JP and AroHT. Lisfranc joint injuries: traumamechanisms and associated injuries. J Trauma 1993; 35: 40–45.
  3. ↑ Urteaga A and Lynch M. Fractures of the central metatarsals. Clin Podiatry Med Surg 1995; 12: 759–762.
  4. ↑ 4.0 4.1 Petrisor BA, Ekrol I and Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int 2006; 27: 172–174.
  5. ↑ Singer G, Cichocki M, Schalamon J, et al. A study of metatarsal fractures in children. J Bone Joint Surg Am 2008; 90: 772–776.
  6. ↑ Zwipp H, Ranft T. Malunited juvenile fractures in the foot region. Orthopaede. 1991;20(6):374–80.
  7. ↑ Johnson VS. In: Bateman JE (ed.) Treatment of fractures of the forefoot in industryFoot Science. Philadelphia, PA: WB Saunders, 1976.
  8. ↑ Zwipp H, Baumgart F, Cronier P, et al. Integral classification of injuries (ICI) to the bones, joints, and ligaments– application to injuries of the foot. Injury 2004; 35: SB3–SB9.
  9. ↑ Zenios M, Kim WY, Sampath J, Muddu BN. Functional treatment of acute metatarsal fractures. A prospective randomised comparison of management in a cast versus elasticated support bandage. Injury. 2005 Jul;36(7):832–5.
  10. ↑ Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, et al. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg 2011; 131: 241–245.
  11. ↑ 11.0 11.1 Sánchez Alepuz E, Vicent Carsi V, Alcántara P, Llabrés AJ. Fractures of the central metatarsal. Foot Ankle Int. 1996;17(4):200–3.
  12. ↑ 12.0 12.1 Stavlas P, Roberts CS, Xypnitos FN, et al. The role of reduction and internal fixation of Lisfranc fracture dislocations: a systematic review of the literature. Int Orthop 2010; 34: 1083–1091.
  13. ↑ Murphy GA. Operative treatment of stress fractures of the metatarsals. Oper Tech Sports Med 2006; 14: 239–247.
  14. ↑ Jameson SS, Augustine A, James P, et al. Venous thromboembolic events following foot and ankle surgery in the English National Health Service. J Bone Joint Surg Br 2011; 93: 490–497.
Created by:
John Kiel on 25 October 2021 15:35:20
Authors:
Last edited:
4 October 2022 12:35:47
Categories:
Lower Extremity | Trauma | Foot | Fractures | Acute
Retrieved from "https://wikism.org/w/index.php?title=Metatarsal_Fracture&oldid=17914"