![]() ![]() The films should include the entire foot to rule out associated injuries that may require treatment. Radiographs in the anteroposterior (AP), oblique, and lateral planes should be obtained. This fracture is a result of tensile stress along the lateral border of the metatarsal during adduction or inversion of the forefoot. An athlete can sustain this injury with a sudden change in direction while the heel is off the ground. Injuries can range from simple isolated fractures of a single metatarsal to severe crush injuries with several fractures and soft tissue compromise. The fracture line extends through the proximal articulation with the fourth metatarsal. True Jones fractures occur in Zone 2 of the fifth metatarsal. Radiograph of Dancer’s fracture - Zone 1 of 5th metatarsal This injury, commonly termed dancer’s fracture (or a pseudo-Jones fracture, a name that should be avoided), can happen after landing awkwardly from a jump or twisting the ankle while running: the ankle passively inverts at the same time the peroneus brevis tendon exerts an eversion force on the metatarsal and a fragment of bone accordingly avulses.įigure 2. Gross deformities are rarely seen.Ī history of direct impact suggests a transverse or comminuted fracture of the shaft, while a twisting-type injury causes an oblique or spiral fracture pattern.Īvulsion fractures at the base of the fifth metatarsal, in Zone 1 where the peroneus brevis and plantar fascia insert, may occur during forced inversion of the foot and ankle while plantar flexed. Patients with a metatarsal fracture present with acute onset of pain, swelling, ecchymosis, and tenderness to palpation in the forefoot, along with difficulty bearing weight. This seemingly arbitrary division is clinically important: fractures in each zone have distinct prognoses and treatment needs. Zone 3 is the diaphysis fractures there are commonly stress fractures.įigure 1. Fractures involving Zone 2, called Jones fractures, are particularly susceptible to nonunion and malunion because this region of the bone has a tenuous blood supply. Zone 2 is at the metaphyseal-diaphyseal junction, distal to the cancellous (styloid) tuberosity. Avulsion fractures from the pull of this tendon are characteristic of zone 1. ![]() Zone 1 is the base of the metatarsal where the peroneus brevis inserts. The fifth metatarsal is divided into 3 zones (as shown), numbered 1 to 3 from proximal to distal. There are no interconnecting ligaments between the 1st and 2nd metatarsals, allowing for independent motion. The first metatarsal is larger than the others and most important for weight-bearing and balance therefore, malunion or malignment at this location is especially poorly tolerated. The forefoot is mobile in the sagittal plane which enables it to accommodate uneven ground by altering the position of each metatarsal head. They act as a rigid lever to aid in propulsion and their flexibility aids in balance. As a unit, the five metatarsals serve as the major weight-bearing complex of the forefoot. The bases of each metatarsal also articulate with each other at the intermetatarsal joints. The base of each metatarsal articulates with one or more of the tarsal bones and the head articulates with the proximal phalanges. They are numbered from 1 to 5, medial to lateral or largest to smallest. The metatarsals are convex bones of the forefoot consisting of a head, neck, shaft, and base. The metatarsals are also subject to stress fractures and can be seen in conjunction with other injuries of the mid-foot (both discussed elsewhere). However, if they go on to malunion or nonunion they can lead to disabling metatarsalagia. Metatarsal fractures are common injuries to the foot often sustained with direct blows to the foot or twisting forces. If adequately assessed these fractures are easy to treat and have a favorable prognosis. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |