(If there in ongoing pain at the site at 2 weeks, see GP). Wear until able to walk without symptoms. What is the usual ED management and follow up for these injuries? Fracture typeĪvulsion fracture at the base of the 5th metatarsal tubercleįirm soled shoe or walking boot (CAM) if more support is required. Displaced fractures (>20 degrees of angulation or significant displacement) Do I need to refer to orthopaedics now?Ĭonsultation on the day of presentation is required for: These are associated with a high incidence of non-union and re-fracture post cast removal due to the tenuous blood supply of this area. Multiple metatarsal fractures that are unstable Significantly angulated or displaced fractures When is reduction (non-operative and operative) required? The second patient also has a fracture of the cuneiform with a loose fragment, fractures of the 3rd and fourth metatarsals, and gross deformity.ħ. What do they look like on x-ray? Fractures of the fifth metatarsal:įigure 10 & 11: Xrays of two separate patient with LisFranc Fracture-dislocation, showing widened space between the first and second metatarsal, fracture at the base of the second metatarsal and avulsed fragment from the tarsal bones. The exception is a suspected Lisfranc injuries, where it should be arranged in consultation with orthopaedics. Plain film – anterior-posterior, oblique and lateral viewsĬT is seldom necessary. What radiological investigations should be ordered?Ĭhildren with pain, swelling and/or deformity to forefoot require foot radiographs. The forefoot will usually appear swollen with bruising, and the patient may be unwilling or unable to bear weight. Occasionally, this is part of a LisFranc injury (tarso-metatarsal fracture-dislocation) 4. Stress from heavy / repetitive intensive trainingįractures of the 2nd, 3rd and 4th metatarsals rarely occur in isolation and commonly result in fracture/s of the adjacent metatarsals.Crush injury caused by a heavy object falling onto the foot or motor vehicle tyre running over foot.How common are they and how do they occur?įractures of the metatarsals are common injuries in children.Ĭhildren 5 year or younger are more likely to fracture 1st metatarsal, whereas children older than 5yrs are more likely to injure 5th metatarsal Growth plate involvement (Salter Harris Classification)ģ.Location of fracture (base, middle, proximal metatarsal).Metatarsal fracture are classified by the following: Metatarsal fractures are common in the paediatric population and rarely require operative management.Ĭare should be taken in differentiating an avulsion fracture of the fifth metatarsal from a Jones fracture, due to the risk of nonunion in the latter.
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