spiral 5th metatarsal fracture image

what are fifth metatarsal fractures? (with pictures)

what are fifth metatarsal fractures? (with pictures)

Fifth metatarsal fractures are breaks in the fifth metatarsal bone, the bone that connects the little toes proximal phalanx that is, the phalanx closest to the ankle to the cuboid bone. This bone can be susceptible to breaks, particularly for very active people. There are three main types of metatarsal fractures: Jones fractures, avulsion fractures, and spiral or oblique fractures. Some of these fractures may also be acute, a sudden break, or chronic, a break that occurs as a result of repeated stress. The method chosen to treat these breaks depends on the type of the break and the person receiving the break.

A Jones fracture, one of the three main types of fifth metatarsal fractures, was named after Sir Robert Jones, the man who first described them. This type of fracture can be caused when stress is placed on the bone while the foot is flexed the toes pointing to the ground while the heel is lifted. Avulsion fractures are caused when one of the ligaments in the foot pulls a fragment out of the bone. This fracture is often caused by the ankle rolling and may accompany a sprained ankle. The oblique fracture is caused by trauma or stress and can result in an unstable break.

There are acute and chronic designations for these fractures. An acute fracture occurs all at once from a single traumatic event. By contrast, chronic fractures, or stress fractures, occur as a result of repeated stress. In cases of chronic breaks, the repeated action can occur over weeks or months before the actual fracture is visible on an X-ray. Most fractures are accompanied by symptoms such as pain, swelling, and bruising. The symptoms of a stress fracture may start off relatively slight and increase as the injury progresses.

When speaking of fifth metatarsal fractures, doctors often separate the bone into three zones. The first zone is close to the proximal area of the bone, that is, the area nearest the ankle. Avulsion fractures usually occur there. The second zone is closer to the tip of the little toe than the first zone. The third zone is the closest zone to the little toe.

Treatment options for fifth metatarsal fractures can be either conservative or surgical, depending on the break and how quickly the patient wants to get back to activities. Oblique fractures in which there is no displacement and avulsion fractures are often treated by immobilizing the foot in structures like a boot or a surgical shoe. Jones fractures may have to be treated with a knee high cast. In either case, there is often a period where a patient should not put any weight on the bone. When surgery is called for, it usually entails the insertion of screws that hold the bone together.

how are foot fractures of the fifth metatarsal treated?

how are foot fractures of the fifth metatarsal treated?

The proximal fifth metatarsal is the most common site of midfoot fractures. [3, 9] Fractures are of 2 general types, the Jones fracture and the pseudo-Jones or tennis fracture. Midshaft (see first image below) and distal fifth metatarsal fractures (see second image below) are less common; these are shown in the images below.

Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB 3rd. Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification. Radiographics. 2015 May-Jun. 35 (3):765-79. [Medline].

Schmoz S, Voelcker AL, Burchhardt H, Tezval M, Schleikis A, Strmer KM, et al. [Conservative therapy for metatarsal 5 basis fractures - retrospective and prospective analysis]. Sportverletz Sportschaden. 2014 Dec. 28 (4):211-7. [Medline].

Pires R, Pereira A, Abreu-E-Silva G, Labronici P, Figueiredo L, Godoy-Santos A, et al. Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain. Ann Med Health Sci Res. 2014 May. 4(3):432-5. [Medline]. [Full Text].

Tollefson B, Nichols J, Fromang S, Summers RL. Validation of the Sonographic Ottawa Foot and Ankle Rules (SOFAR) Study in a Large Urban Trauma Center. J Miss State Med Assoc. 2016 Feb. 57 (2):35-8. [Medline].

Zenios M, Kim WY, Sampath J. 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. [Medline].

Hunt KJ, Goeb Y, Esparza R, Malone M, Shultz R, Matheson G. Site-Specific Loading at the Fifth Metatarsal Base in Rehabilitative Devices: Implications for Jones Fracture Treatment. PM R. 2014 May 28. [Medline].

Benson E, Conroy C, Hoyt DB, Eastman AB, Pacyna S, Smith J, et al. Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes. Accid Anal Prev. 2007 Jul. 39(4):794-9. [Medline].

Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, et al. Demographics, Mechanisms of Injury, and Concurrent Injuries Associated With Calcaneus Fractures: A Study of 14 516 Patients in the American College of Surgeons National Trauma Data Bank. Foot Ankle Spec. 2016 Nov 28. [Medline].

Knight JR, Gross EA, Bradley GH, Bay C, LoVecchio F. Boehler's angle and the critical angle of Gissane are of limited use in diagnosing calcaneus fractures in the ED. Am J Emerg Med. 2006 Jul. 24(4):423-7. [Medline].

Richter J, Schulze W, Klaas A, Clasbrummel B, Muhr G. Compartment syndrome of the foot: an experimental approach to pressure measurement and release. Arch Orthop Trauma Surg. 2008 Feb. 128(2):199-204. [Medline].

Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009 Apr. 16(4):277-87. [Medline].

Robert Silbergleit, MDProfessor, Department of Emergency Medicine, University of Michigan Medical School Robert Silbergleit, MD is a member of the following medical societies: American Association for the Advancement of Science, Alpha Omega Alpha, American Stroke Association, American Academy of Emergency Medicine, American Heart Association, National Association of EMS Physicians, Sigma Xi, Society for Academic Emergency Medicine, Society for NeuroscienceDisclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhDAdjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. for: Medscape.

Trevor John Mills, MD, MPHChief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency PhysiciansDisclosure: Nothing to disclose.

Francis Counselman, MD, FACEPChair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency MedicineDisclosure: Nothing to disclose.

5th metatarsal shaft

5th metatarsal shaft "dancer's" fracture - footeducation

A twisting injury to the ankle and foot may cause a long fracture of the 5th metatarsal shaft the bone that attaches the little toe to the midfoot (Figure 1). During this injury, the 5th metatarsal is twisted by a strong force resulting in a spiral fracture. This 5th metatarsal Dancers fracture causes localized pain, swelling, and difficulty walking. In many instances, this type of fracture can be treated non-operatively, with relative immobilization in a walking boot combined with limited weight-bearing. It typically takes about 6 weeks for adequate bone healing to occur, before patients can start to significantly increase their activity level. It often takes 4 or more months for a full recovery to occur.

**There is another fracture that may also be referred to as adancers fracture. However, since this fracture of the fifth metatarsal was first described in ballet dancers, it has become known as a dancers fracture as well.

A patient who suffers a 5th shaft fracture (See Figure 1) commonly gives a history of a twisting injury to their ankle and foot (inversion and plantarflexion injury), similar to what occurs with an ankle sprain (Figure 2). An acute rolling of their ankle while pointing the toes down can also fracture the shaft of the 5th metatarsal (See Figure 1). This will produce immediate pain over the outside aspect of the foot near the toes. It can be associated with significant swelling. Weight bearing on the injured foot may be difficult due to pain and discomfort. Over time, the skin can turn black and blue. It will be associated with quite specific local tenderness over the bone near the base of the fifth toe and on the outside of the foot (the 5th metatarsal).

When pressing on the outside of the foot, there will be marked tenderness over the 5th metatarsal. There may be tenderness and swelling over a large area of the outside of the foot. However, the main tenderness will usually be just before the base of the fifth toe.

X-rays of the foot will reveal a long oblique fracture of the shaft of the 5th metatarsal. The size of the fractured fragment may vary considerably. There will be gapping at the fracture and there may be some shortening or rotation of the fracture (Figures 3A-3B).The usual fracture pattern is a spiral running from the outside aspect of the bone (distal lateral) near the toes to the inside aspect of the bone near the ankle (proximal medial).

A 5th metatarsal shaft Dancers fracture is an injury that is usually treated non-operatively. The fracture has a very high rate of healing with non-operative treatment. Treatment involves relative rest and time to allow the fracture to heal. Typically, patients are placed in awalking boot. Although weight bearing is allowed, for the first few weeks, they will have to significantly limit their walking and may needcrutches due to pain and discomfort. As the swelling settles and the fracture starts to heal, they can begin walking more extensively in the boot. Usually by 6 weeks, there is enough healing to allow them to transition to astiff-soled shoewith lots of padding. This is a frustrating injury because it takes a long time for healing to occur. Patients are often still symptomatic 6 to 8weeks or more after this injury. They can usually resume dance activities by 10-12 weeks and return to performance level by 19 weeks. It can be many months before the bone is completely healed and a full recovery has been achieved.

Surgery may be needed when there is complete displacement of the fracture fragments or failure to heal with non-operative treatment after several months. In these cases, the bone fragments are repositioned and stabilized with screws and/or a plate.

management of spiral diaphyseal fractures of the fifth metatarsal: a case series and a review of literature - sciencedirect

management of spiral diaphyseal fractures of the fifth metatarsal: a case series and a review of literature - sciencedirect

There is a paucity of literature when it comes to fifth metatarsal diaphyseal fractures.There is a bimodal distribution of age of presentation of this fracture.Non-surgical management results in excellent functional outcome regardless of initial displacement.This is the first study to report on outcomes of non-operative measures.A hard soled shoe is our preferred mode of immobilisation with excellent patient satisfaction and functional outcomes.

Spiral diaphyseal fractures of the fifth metatarsal can present with significant displacement. It is considered that non-operative management is sufficient in most cases but there is no clear consensus as to what this may be. This study reports the functional outcome of this injury in a small patient cohort and is the first study to report on outcomes of different non-operative measures.

This is a retrospective study of 33 consecutive patients presenting to a central London teaching hospital who were managed by a variety of treatment modalities depending on surgeon preference which included a boot or a rigid sole shoe. Demographic data was obtained and time to pain free walking and return to normal footwear was recorded. The patients were asked how restrictive the injury was on a Likert scale (15). The average final follow up was 12 months.

All fractures were managed conservatively with excellent functional outcomes. Those patients managed in a shoe had a statistically significant shorter average time to return to pain free walking (4.6 vs 8.4 weeks, p=0.027) and average time to return to normal footwear (6 vs 7.3 weeks, p=0.044) in comparison to a boot. Patients managed in a shoe reported the injury was less restrictive in comparison to patients managed in a boot (p=0.0002). The average time to evidence of bony union was 8.3 weeks. There were 3 delayed unions.

All patient in this series were treated without surgery regardless of the degree of displacement. Conservative management of this fracture in a rigid sole shoe resulted in better outcomes and was reported to be less restrictive by the patients in comparison to a boot. On this basis, non-surgical management of these injuries is recommended in a shoe, full weight bearing with early range of movement of the ankle.

5th metatarsal fractures: symptoms, diagnosis, and treatment

5th metatarsal fractures: symptoms, diagnosis, and treatment

A fifth metatarsal fracture is a break located in the long, laterally located tubular bone of the forefoot that is attached to the small toe. Fractures of this bone can occur due to direct injury to the outside of the foot or can occur over time. Fractures that occur over a period of time due to overuse are termed stress fractures. Patients experiencing tenderness, swelling and pain on the outside of the foot may have suffered a fifth metatarsal fracture. In addition, hesitancy with weight-bearing can contribute to the diagnosis. Treatment options include conservative and surgical methods; however, the type of care varies depending on the patient and the nature of the fracture.

Anatomy and Classification:The foot is a complex structure that has a role in weight bearing and walking. It is composed of seven tarsal (ankle) bones, five metatarsals, and fourteen phalanges. The metatarsals are responsible for bridging the distance between the tarsal bones and phalanges. The metatarsals are numbered 1-5 beginning with the great toe. Therefore, the 5thmetatarsal is located on the lateral side of the foot. Fractures of the 5thmetatarsal can be classified into three categories including:

Tuberosity Avulsion Fracture (Dancers Fracture) A fracture that occurs when the ligaments and tendons that attach to the head of the 5thmetatarsal pull off a part of the bone. Its name originates from its association with dancers who often sustain this injury when excessively twisting or rotating the foot and ankle.

How will the doctor assess my foot?From the moment you take your first step into the office, your physician will begin to assess the injury by observing your gait. Once in the exam room, your doctor will evaluate your range of motion and sensation to the lateral foot. X-rays will also be ordered in order to confirm a fracture and classify it accordingly.

Treatment and Recovery: Fortunately, 5thmetatarsal fractures can often be treated conservatively without the need for surgery. In a typical Jones fracture, patients may be placed in a boot and instructed to remain in a non-weight bearing state for 6 weeks. Contrarily, if the patient is an athlete, surgery may be indicated to ensure proper fracture union and to decrease the healing time. In addition, dancers fractures tend to follow the same non-operative treatment pattern as Jones fractures. Lastly, shaft fractures can be treated conservatively, but may require surgery if the bone fragments are displaced. Regardless of the form of treatment, the physician may order additional x-rays to ensure proper bone healing.

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