INJURIES OF METATARSAL BONES.pptx. .

Injuries of metatarsal bones

1. Dr.akshay INJURIES OF METATARSAL BONES

2. Introduction Metatarsal fractures are relatively common and are of four types: (1) crush fractures due to a direct blow; (2) a spiral fracture of the shaft due to a twisting injury; (3) avulsion fractures due to ligament strains; (4) insufficiency fractures due to repetitive stress

3. Clinical Features In acute injuries pain, swelling and bruising of the foot are usually quite marked; with stress fractures, the symptoms and signs are more insidious.

4. Radiological Features X-rays should include routine anteroposterior, lateral and oblique views of the entire foot; multiple injuries are not uncommon. Undisplaced fractures may be difficult to detect and stress fractures usually show nothing at all until several weeks later.

5. Treatment Treatment will depend on the type of fracture, the site of injury and the degree of displacement.

6. UNDISPLACED AND MINIMALLY DISPLACED FRACTURES These can be treated by support in a below-knee cast or removable boot splint; the foot is elevated and active movements are started immediately, partial weight bearing for about 4–6 weeks. At the end of that period, exercise is very important and the patient is encouraged to resume normal activity. Slight malunion rarely results in disability once mobility has been regained.

7. DISPLACED FRACTURES Displaced fractures can usually be treated closed. The foot is elevated until swelling subsides. The fracture may be reduced by traction under anaesthesia and the leg immobilized in a cast – non-weight bearing – for 4 weeks. Alternatively the fracture position might be accepted, depending on the degree of displacement. For the second to fifth metatarsals, displacement in the coronal plane can be accepted and closed treatment, as above, is satisfactory.

8. DISPLACED FRACTURES For the first metatarsal and for all fractures with significant displacement in the sagittal plane (i.e. depression or elevation of the displaced fragment) open reduction and internal fixation with K-wires, or better with stable fixation using a plate and small screws, is advisable. A below-knee cast is applied and weight bearing is avoided for 3 weeks; this is then replaced by a weight bearing cast for another 4 weeks.

9. Fractures of the metatarsal neck Fractures of the metatarsal neck have a tendency to displace, or re-displace, with closed immobilization. It is therefore important to check the position repeatedly if closed treatment is used. If the fracture is unstable, it may be possible to maintain the position by percutaneous K-wire or screw fixation. The wire is removed after 4 weeks; cast immobilization is retained for 4–6 weeks.

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