Metatarsal Fracture
synonyms: metatarsal shaft fracture
Metatarsal Fx ICD-9
- 825.25 (closed fracture of metatarsal bone)
- 825.35 (open fracture of metatarsal bone)
Metatarsal Fx Etiology / Epidemiology / Natural History
- Untreated displaced fractures (espcially sagittal plane angulation) can lead to transfer metatarsalgia and chronic pain.
Metatarsal Fx Anatomy
- 1st MT: shorter and wider; bears 1/3 of body weight via tibial and fibular sesamoids. Tibialis anterior insertion provides varus/supination/elevation forces; peroneous longus insertion provides valgus/pronationdepression forces.
- Lesser MT's: bear 1/6 body weight each.
Metatarsal Fx Clinical Evaluation
- Pain, swelling in the forefoot.
- High energy injuries can result in compartment syndrome
- Document NV exam.
Metatarsal Fx Xray / Diagnositc Tests
- Xray: A/P, Oblique, Lateral foot views generally demonstrate fracture.
- CT: consider if associated midfoot fractures are possible.
Metatarsal Fx Classification / Treatment
- Nondisplaced 1st metatarsal fx = NWB cast for 6 wks
- Displaced 1st metatarsal fx = ORIF, generally fixed with plates/screws. 1st metatarsal must be treated to preserve the head as a major wt bearing point.
- Nondisplaced isolated lesser metatarsal: hard soled shoe and progressive WBAT. Displaced isolated lesser metatarsal: closed reduction and casting for 3 wks, followed by hard soled shoe and progressive WBAT.
- Nondisplaced multiple lesser metatarsals: hard soled shoe, brief period of NWB follopwed by progressive WBAT.
- Displaced Multiple lesser metatarsals: require reduction and Kwires or ORIF
- important to metatarsal head positions
Metatarsal Fx Associated Injuries / Differential Diagnosis
Metatarsal Fx Complications
Metatarsal Fx Follow-up Care
- Post-op /Initial: NWB, Hard soled shoe. Elevation.
- 7-10 Days: xray to ensure reduction is maintained. Continue hard-soled shoe, may brpgress with weight bearing depending on fracture stability, activity modifications.
- 6 Weeks: Remove k-wire. Advance weight bearing in hard-soled shoe dependent on fracture union on xrays.
- 3 Months: Resume full activities based on union. Consider bone stimulator if union not evident on xray.
- 1Yr: assess outcomes / follow-up xrays.
Metatarsal Fx Review References
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