In fact, they are second only to the tibia, which is the most common place for a stress fracture. The second, third, and fourth metatarsals are most prone to stress fractures. They worsen over time and are sometimes not evident on x-rays until the bone has started to heal. Stress fractures are caused by repetitive actions or impacts to the bones. Acute fractures, also called traumatic fractures, happen instantaneously and are caused by an impact, such as when a heavy object falls on the bones. There are two types of metatarsal fractures: acute and stress fractures. Injuries to the metatarsal bones are very common and can happen in a number of ways, but most commonly occur when a heavy object falls on them or when they are twisted during a fall. Treatment of a metatarsal fracture depends heavily on which bone is fractured. Metatarsal fractures do not discriminate based on age, race, or gender-they can happen to anyone at any time.Įach metatarsal is broken down into segments: the head, neck, shaft, and base. Our metatarsal bones bear much of our weight when we are standing, walking, or running. Instead they are numbered, starting with the big toe, which is known as the first, then continuing with the second, third, fourth, and fifth metatarsals (the fifth is the pinky toe). The preferred method of revision treatment is intercalary autogenous bone grafting and dorsal plating.Our metatarsal bones are the long bones located in our feet between the tarsal (ankle) bones and the phalanges of the toes.Įach foot has five metatarsal bones, which are collectively referred to as the metatarsus, and none of them have individual names. Several techniques have been described to revise these nonunions. Highly comminuted or segmental fractures of the metatarsal diaphysis can result in painful nonunion. The treating physician may be tempted to address the symptomatic metatarsal however, correcting the malunited metatarsal is more prudent. When there is a dorsiflexory sagittal plane malunion, the patient will present with symptomatic metatarsalgia juxtaposition to the malunited metatarsal. Much like metatarsal head malunions, a sagittal plane malunion of the shaft is corrected with realignment osteotomies. ![]() This will prevent sagittal plane malposition of the metatarsal. The external fixation bars should be oriented parallel to the long axis of the metatarsal. The surgeon should pay close attention to the metatarsal declination angle when using external fixation. This technique is most useful in highly comminuted or open fractures. Another option for stabilizing these fractures is external fixation. This provides stabilization of the fracture without disrupting the biology around the fracture. Bridge plating allows the surgeon to “bridge or span” the comminuted segment while concurrently receiving osseous stability from the bone proximal and distal to the area of comminution. Bridge plating works well for comminuted metatarsal shaft fractures. Deviation from this technique can lead to healing complications including nonunion and malunion. ![]() Because of this, additional dorsal plating is recommended for neutralization. The perpendicular placement of this screw is challenging due to inference of the adjacent metatarsals. Spiral fractures should be stabilized with interfragmentary fixation. A vertical oriented fracture can be treated in with a 0.062 in. When the fracture is displaced and surgical treatment is being considered, the pattern of the fracture helps determine the most appropriate fixation. Certain fracture patterns of the metatarsal shafts are more appropriately treated with surgical stabilization. 10.2).įractures of the central metatarsal diaphysis are often treated nonsurgically as well. A dorsal wedge is removed from the metatarsal head, and the viable plantar cartilage is rotated dorsally (Fig. These osteotomies use the viable and uninjured plantar cartilage to interface with the base of the proximal phalanx. Rotational dorsal wedge osteotomies have shown to be an excellent option. If the articular insult is large, excision is not recommended and more advance reconstructive techniques should be considered. If the fragment is small, simple excision is sufficient treatment. The treatment depends on the size of the fragment. These treatments include debridement, excision, synovectomy, and dorsal closing-wedge osteotomy. However, several authors have described a variety of applicable treatments for osteochondral defects of the metatarsal head. The majority of the literature pertains to reconstruction of avascular necrosis. Osteochondral injuries are often caused by axial load, and the cartilage surface sustains a shear-type injury. ![]() Complication of these injuries can result in osteochondral defects, avascular necrosis, or more commonly sagittal plane malunion.
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