The easiest way to distinguish among the fractures is to locate the medial tip of the fracture line and compare its location to the intermetatarsal joint. There are three basic types of fractures including tuberosity avulsion fractures, acute proximal diaphyseal fractures, and stress fractures of the proximal diaphysis. The fifth metatarsal can be divided into three parts: the tuberosity, the metaphysis and the proximal diaphysis. Suboptimal treatment can lead to delayed union, re-injury and chronic disability. A difference in millimeters of location can lead to a vastly different prognosis and treatment plan. What is the correct diagnosis in this patient?įractures of the proximal fifth metatarsal pose an important diagnostic challenge. Non-union is associated with pain, poor ambulation, and potential need for surgery.Ī 22-year-old man presents to the emergency department with foot pain after landing on his foot improperly while playing basketball last night. Athletes may be treated with intramedullary screw fixation. Zone 2 and 3 fractures are at high risk of complication, even with immobilization and non-weightbearing.Zone 1 fractures heal well, and patients can resume activities as tolerated.If unsure, treat as a Zone 2 or 3 injury: splint and ensure orthopedic follow up!.Zone 3: non-weightbearing for minimum 6 weeks, place in short leg posterior splint or boot, ensure orthopedic follow up within 1 week.Zone 2: non-weightbearing for minimum 6 weeks, place in short leg posterior splint or boot, ensure orthopedic follow up within 1 week.Zone 1: weightbearing as tolerated, hard-sole shoe or walking boot, 1-2 weeks of shoe/boot for comfort.Management revolves around specific diagnosis:.Provide analgesia and recommend elevation and ice for swelling.X-ray typically does not demonstrate a clean fracture line, but rather widened fracture site with cortical thickening. This fracture is associated with foot deformities and sensory neuropathy. Zone 3: Proximal diaphyseal fracture distal to 4 th-5 th metatarsal articulation.This is a vascular watershed area and is at high risk of non-union due to poor blood supply. Zone 2: Jones fracture is a fracture of the metaphysial-diaphysial junction, or 4 th-5 th metatarsal articulation.X-ray will show fracture line into metatarsocuboid joint. Result of bony fragment detachment by ligament. Zone 1: Pseudo-Jones fracture or avulsion involving the proximal tubercule.Obtain foot (AP, lateral, oblique) and ankle X-rays.Patients will meet criteria for imaging per Ottawa foot rules (pain at base of 5 thmetatarsal).Patients often have pain with weightbearing or are unable to bear weight.
Fractures of the 5 th metatarsal account for 68% of metatarsal fractures and are the most common.Zone 3: repetitive minor trauma (stress).Background: Due to fracture of the 5 th metatarsal base, broken into 3 separate zones, primarily on mechanism and fracture site.What are your next steps, and what is the likely diagnosis?Īnswer : Proximal 5 th Metatarsal Fracture The base of her 5 th metatarsal is tender to palpation, with swelling and ecchymosis. She has some minor ankle pain, but her lateral foot is painful to touch or with weight-bearing. She is able to bear weight, but with pain. We’ll keep it short, while you keep that EM brain sharp.Ī 23-year-old female presents with left foot pain after rolling her ankle in volleyball. Welcome to an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. Author: Brit Long, MD EM Attending Physician, San Antonio, TX) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital)