![]() Open reduction and plate fixation may be required in comminuted fractures. Midshaft fractures can be crossed k-wired (2x 1.8 or 2mm wires) after closed or open reduction. Shereff (1990) suggests that reduction is required with displacement >3-4mm and angulation >10 degrees in the sagittal plane Multiple fractures of the metatarsals may increase the likelihood of needing surgery because of the loss of inherent stability from adjacent metatarsals. A residual deformity at the dorsal apex of a fracture can result in a corn or exostosis. In the 1st metatarsal correction of the displacement in the transverse plane aims to prevent a post traumatic hallux valgus or varus. Translational displacement can result in mechanical impingment and interdigitial neuroma. Sagittal displacement of the metatarsal head and/or shortening (in oblique fractures) will alter weight bearing and can result in metatarsalgia and plantar keratosis. In displaced fractures the goal of treatment is to preserve or restore alignment of the metatarsal heads, to maintain normal weight bearing. Basal fractures have the restraints of the capsular attachments, interosseous ligaments as well as the tibialis posterior and peroneus longus insertions. ![]() Most of these fractures, however, were of the 5th metatarsal.ĭisplacement is more common in the shaft and distal fractures. However AOFAS scores were higher and pain scores lower in the elastic support bandage group at 3 months and there were plaster related complications such as DVT in the casted group. There was no difference in mobility, analgesic requirements or union at 3 months. This was a RCT of 50 patients with acute lesser metatarsal fractures, treated with walking below knee cast vs elastic support bandage. The only prospective study available is by Zenios (2005). Methods used include strapping, wooden soled shoes or walking cast for up to 4-6 weeks. Undisplaced fractures are treated symptomatically. In delayed presentation/ malunion, an AP and lateral weight bearing can be supplemented with a weight bearing tangential view of the metatarsal heads to assess deformity.(Rammelt 2004). In the presence of several basal metatarsal fractures/ significant mechanism or severe soft tissue injury a CT to rule out a Lisfranc injury may be required.ġst metatarsal proximal metaphyseal fractures can be difficult to see on plain radiographs and oblique views are recommended.(Lucas 1997) Oblique views are particularly useful in proximal injuries to assess the Lisfranc joints. ImagingĪP and lateral x-rays should be obtained as standard. A high index of suspicion is required and urgent fasciotomies performed if clinically suspected. Crush injuries are mainly transverse or comminuted and are associated with compartment syndrome of the foot. The mechanism of injury can be variable from RTA to crush injury. Zwipp (2004) described the AO classification of injuries of the foot (as applied to the metatarsalsĪs with all fractures they can present with pain, swelling, bruising and deformity.Whilst not as well defined as the 5th MT fracture, there are several classifications that can be used. All IIIB fractures resulted in an amputation secondary to infection and poor wound healing because of significant soft tissue damage( 1 toe, 1 ray, and 2 Symes). There is next to no literature on 1st metatarsal fractures case reports suggest they are commonest at the proximal metaphysisĪ retrospective study of 10 open metatarsal fractures (Hoxie 2007), contained 4 grade I, 2 grade II and 4 grade IIIB fractures. ![]() 3rd and 4th mainly occur in the distal metaphysis. Second metatarsal fractures are commonest in the diaphysis and distal metaphysis. Fracture of the 4th MT is uncommon because of the flexibility of the ray and its protected position, and of the 1st because of its relative size and mobility. Other studies show similar figures with 2nd and 3rd more common than 1st and 4th.(Sanchez 1996, Rammelt 2004). Nine percent had multiple fractures, 1.2% were open and 1.9% had an associated Lisfranc injury The overall incidence was 6.7 per 10,000 population. Petrisor (2006), looked retrospectively at 355 patients with 411 metatarsal fractures. In children 61% of foot fractures are in the metatarsals. Most of the literature and studies available relate to stress fractures rather than acute injury of the metatarsals with mainly case reports and very small studies on acute fractures. The metatarsals also the most common site of stress fractures in the skeleton. 2nd and 3rd MT fractures are more commonly seen than 1st and 4th, and all these fractures are less common than 5th metatarsal fractures. Metatarsal injuries range from simple fractures to severe crush injuries with multiple fractures and soft tissue damage. ![]()
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