In most cases, surgery is not necessary. The goal of treatment of fifth metatarsal fractures is successful healing of the bone and establishing a pain free gait pattern with normal weight bearing. There was a significant difference in the time for bone union. Protecting the fracture is the primary treatment; stay away from the activity that triggered the injury or any activity that causes pain at the fracture site. A Zone 3 injury is a proximal diaphyseal fifth metatarsal stress fracture, defined as a stress fracture in the zone of the proximal fifth metatarsal immediately distal to the anatomic area of the Jones fracture. Zelko RR, Torg JS, Rachun A. Proximal diaphyseal fractures of the fifth metatarsal – treatment of the fractures and their complications in athletes. A fifth metatarsal fracture is a break of the most lateral of the metatarsals (long bones in the foot). A mechanical model of metatarsal stress fracture during distance running. Please see the picture below to understand where this injury is. Ochenjele G, Ho B, Switaj PJ, Fuchs D1, Goyal N, Kadakia AR. The average distance from apex to base was 42.6 ± 5.8 mm in the AP view and 40.4 ± 6.4 mm in the lateral view. The average straight segment length was 52 mm, which corresponded to 68 percent of the overall length of the metatarsal from its proximal end. Treatment options include conservative and surgical methods; however, the type of care varies depending on the patient and the nature of the fracture. The mean time for bone union in group A (32 patients with complete fracture) was 67.5 days ± 28.8 and it was 103.2 days ± 47.7 for group B (54 patients with incomplete fracture). Metatarsal fracture treatment. The metatarsals run from about the mid-point of your arch to the balls of your feet (which are a particularly padded area of the sole, located just under the heads of the metatarsals). These fractures typically are treated without surgery using a cast, boot, or hard-soled shoe and tend to heal within 6-8 weeks. These fractures almost always heal well with time and therefore follow up clinic appointments are not always needed. There is much debate about the diameter and length of the screw that the surgeon uses for fixation. Direct blows and twisting injuries cause many of these fractures. You have sustained a fracture to the mid-shaft of the 5th Metatarsal of your foot. After forming the guide hole, use a solid drill bit to create the guide hole. The authors concluded that one could avoid excessive screw length by keeping screw length at less than 68 percent of the length of the fifth metatarsal.6 A greater than 4.5 mm diameter screw might be needed to provide adequate fixation for most study patients since the isthmus of the medullary canal for most was greater than 4.5 mm. Crutches should be provided and weight bearing allowed as tolerated, with follow-up in three to five days. This area is between the base and shaft of the fifth metatarsal, a … I believe one should treat the chronic fifth metatarsal fracture differently. Regardless of the form of treatment, the physician may order additional x-rays to ensure proper bone healing. In addition, hesitancy with weight-bearing can contribute to the diagnosis. Tuberosity fractures (Zone 1) have a good prognosis with conservative treatment. Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review. This is the first paper investigating the use of low-intensity pulsed ultrasound in delayed union of fifth metatarsal fractures. Regardless of the form of treatment, the physician may order additional x-rays to ensure proper bone healing. Regardless of treatment, the clinical outcomes were not different between the two fracture locations. From the moment you take your first step into the office, your physician will begin to assess the injury by observing your gait. In Conclusion metatarsal fractures can often be treated conservatively without the need for surgery. One should instruct the patient to leave the dressing alone until the first post-op visit at approximately seven days. This area of the bone has low blood flow. I believe it would be better to treat these fractures using the combination of the diagnostic classifications from the two aforementioned studies. The use of screw fixation healed non-unions in 97 percent of cases. One needs to fill the graft site within the calcaneus with an allograft. Keep weight off the leg and apply ice to reduce swelling. By then subdividing them into either acute or chronic, this can give the surgeon the best method for treatment and give the patient a realistic timeframe for the return to activity. Objective. For screw diameter, surgeons should use the AP view because canal shape is elliptical and the study found width to be significantly smaller in the AP view. One should start the incision proximal to the styloid process in order to ensure proper screw placement. Swivel your feet from side to side to slide the towel. However, recent reports have described failures after screw fixation in athletes. Once in the exam room, your doctor will evaluate your range of motion and sensation to the lateral foot. For further reading, see “A Closer Look At Fixation For Fifth Metatarsal Fractures” in the September 2012 issue of Podiatry Today, “Essential Insights On Treating Fifth Metatarsal Fractures” in the April 2006 issue or “Current Concepts In Treating Fifth Metatarsal Fractures” in the May 2010 issue. Avulsion fracture.In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. Experiencing acute or chronic foot pain? This involves placing a guide wire … Fractures of the 5thmetatarsal can be classified into three categories including: Tuberosity Avulsion Fracture (Dancer’s Fracture) – A fracture that occurs when the ligaments and tendons that attach to the head of the 5th metatarsal pull off a part of the bone. This normally takes approximately The graft typically comes through a lateral incision along the body of the calcaneus. Traditionally, this area is classified based on the work of Torg and colleagues in their classic article describing the zones of injury.1 Zone 1 refers to a tuberosity fracture. Zone 2 or 3 injuries have a less predictable prognosis when it comes to conservative treatment. All fractures healed between 4.8 and 9.8 months with a 78 to 82 percent patient satisfaction rate. In addition, dancer’s fractures tend to follow the same non-operative treatment pattern as Jones fractures. Orthop Clin North Am 2001; 32(1):171-80. 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