Early surgical fixation reduces time to healing and time to return to sports. Can be classified as Salter-Harris I type fracture. Partial epiphyseal avulsion with or without fracture line. Type IV Intra-articular comminuted fracture. Fracture line usually makes a right angle to the long axis of the metatarsal base. Nondisplaced avulsion fractures of the fifth metatarsal tuberosity require symptomatic therapy only (elastic or soft bandage followed by firm shoe when tolerated).įractures of the proximal fifth metatarsal diaphysis require more aggressive treatment, such as early surgical fixation or prolonged casting with no weight bearing. Type III Avulsion fracture of styloid process of 5th metatarsal. Stress fractures of the metatarsal shaft usually heal well without immobilization and typically respond well to cessation of the causative activity for four to eight weeks. Most nondisplaced metatarsal shaft fractures require only a soft elastic dressing or firm, supportive shoe and progressive weight bearing. If there is more than 3 to 4 mm displacement in a dorsal or plantar direction, or if dorsal/plantar angulation exceeds 10 degrees, reduction is usually required. Many of these fractures are easy to treat and. If radiography reveals a normal position seven to 10 days after injury, progressive weight bearing may be started, and the cast may be removed three to four weeks later.įractures of a single metatarsal with lateral or medial displacement usually heal well without correction and may be managed like nondisplaced fractures. Metatarsal fractures are common injuries to the foot often sustained with direct blows or twisting forces. Nondisplaced fractures of the proximal portion of metatarsals 1 through 4 can be managed acutely with a posterior splint followed by a molded, non–weight-bearing, short leg cast. Treatment of fractures distal to the tuberosity should be individualized based on the characteristics of the fracture and patient preference. Radiographs should be carefully examined to distinguish these fractures from tuberosity fractures. Proximal fifth metatarsal fractures that are distal to the tuberosity have a poorer prognosis. Avulsion fractures of the proximal fifth metatarsal tuberosity can usually be managed with a soft dressing. Stress fractures of the first to fourth metatarsal shafts typically heal well with rest alone and usually do not require immobilization. Nondisplaced fractures of the metatarsal shaft usually require only a soft dressing followed by a firm, supportive shoe and progressive weight bearing. Injuries to this ligament require referral or specific treatment based on severity. If the midfoot is injured, care should be taken to evaluate the Lisfranc ligament. Referral is generally indicated for intra-articular or displaced metatarsal fractures, as well as most fractures that involve the first metatarsal or multiple metatarsals. The fracture should then be characterized and treatment initiated. Initial evaluation should focus on identifying any conditions that require emergent referral, such as neurovascular compromise and open fractures. Patients with metatarsal fractures often present to primary care settings.
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