The Common Vein Copyright 2011
Definition
Fractures of the metatarsals are usually caused by direct trauma, twisting, avulsion, and stress trauma.
First metatarsal fractures are usually caused by direct trauma. Second, third and fourth metatarsal fractures are much more common than first metatarsal fractures. An indirect twisting mechanism may result in a spiral fracture.
Fifth metatarsal fractures can be divided into three zones of fractures.
Zone 1 is the cancellous tuberosity at the most proximal part of the base and makes up 93% of fractures. The peroneal brevis and plantar fascia insert here and this part of the metatarsal is part of the metatarsocuboid joint.
Zone 2 injuries are known as Jones fractures and are due to adduction or forefoot inversion. Zone 2 injuries occur at the metaphyseal-diaphyseal junction.
Zone 3 fractures are proximal diaphyseal stress fractures seen mainly in athletes.
Any other site of fracture to the fifth metatarsal is termed a dancer’s fracture.
Metatarsal stress fractures are most common in athletes.
The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, metatarsalgia or osteoarthritis.
The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging.
Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI.
Treatment for most metatarsal fractures is with a short leg cast or removable boot for 4 to 6 weeks. Some fractures such as a true Jones fracture of zone 2 of the fifth metatarsal may require an ORIF surgery to help with union of the fracture fragments.
Stress fractures are treated non-operatively initially but can require surgical fixation if they persist.
References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.