Multiple metatarsal fractures have traditionally been an indication for surgical treatment. Patients with elastic bandage treatment had significantly higher functional scores and less pain. All patients achieved radiographic union at mean follow-up of 3 months. Poor outcomes were considered associated with comminution, sagittal plane displacement, open fractures, or severe soft tissue injury.Īn RCT of 50 patients with minimally displaced lesser metatarsal fractures compared cast immobilization with elastic bandage support. A study comparing fixation management with K-wire fixation (21 patients) and casting (36 patients) reported no significant difference in outcomes. There are very few studies which report the outcomes of fractures of the first four metatarsals. Mini-fragment and low profile plates are preferred to avoid soft tissue irritation.Ĭlosed reduction and intramedullary percutaneous K-wire pinning can be performed by either a retrograde or anterograde technique, the former being more commonly practiced. For oblique or spiral fractures, small lag screw fixation can provide additional stability along with plate fixation. Surgical options include closed reduction and K-wire fixation, open reduction and internal fixation or in cases of poor soft tissue envelope external fixation may be used. In case of considering surgery, the concept of restoring length, alignment and rotation should be followed. Transverse plane displacement is usually better tolerated but can be associated with interdigital nerve impingement. Sagittal plane displacement is poorly tolerated as it alters the weight-bearing relationship of the metatarsal heads and may result in painful callus and metatarsalgia. However some of these patients may end up with an incompetence or deformity that either exacerbates metatarsalgia or necessitates late surgery. Majority of these fractures heal within 6 weeks and recovery back to normal activities follows soon after. This has generally been observed to result in very satisfactory outcome. In case of first metatarsal fractures, more cautious weight-bearing is advised due to higher risk of displacement in view of excessive load bearing on the medial column. With any of these options weight-bearing is allowed as per comfort. Usual options include a wooden-sole shoe, plaster shoe, walker boot or less frequently a below-knee light weight cast. Undisplaced and minimally displaced fractures are treated conservatively with immobilization for a period of 4 to 6 weeks. Majority of these fractures heal uneventfully with conservative treatment, however a small percentage may lead to non-union or mal-union resulting in significant disability and pain. Repetitive strain can cause stress type fractures.įor clinical purpose, metatarsal fractures are classified by anatomic location as base, shaft and neck fractures.ĪP, lateral, and oblique radiographs of the foot are routinely obtained, ideally with the patient bearing weight, however due to initial pain and swelling, weight bearing views may not be possible. Indirect injuries include falls on plantarflexed and fixed foot or inversion injuries. Direct injuries include falls, motor vehicle accidents, crush injuries or a fall of heavy objects. It does not store any personal data.Mechanism of injury may be direct, indirect or repetitive trauma. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. The cookie is used to store the user consent for the cookies in the category "Performance". This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other. The cookies is used to store the user consent for the cookies in the category "Necessary". The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The cookie is used to store the user consent for the cookies in the category "Analytics". These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly.
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