Episode 165.0 – Foot Fractures
A look at foot fractures – which can be splinted and which may need the OR. Hosts: Audrey Bree Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Foot_Fractures.mp3 Download Leave a Comment Tags: Orthopedics Show Notes Episode Produced by Audrey Bree Tse, MD Background: * Why do we care about Jones fractures? * Propensity for poor healing due to watershed area of blood supply * Fifth metatarsal fractures account for 68% of metatarsal fractures in adults * Proximal 5th metatarsal fractures are divided into 3 zones (93% zone 1, 4% zone 2, 3% zone 3) * Zone 1 (pseudo-Jones): * Tuberosity avulsion fracture * Typically avulsion type injuries due to acute episode of forefoot supination with plantar flexion * Typical fracture pattern is transverse to slightly oblique * Zone 2 (Jones fracture): * Fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal * Typically acute episode of large adduction force applied to forefoot with the ankle plantar flexed * Zone 3: * Proximal diaphyseal stress fracture * Typically results from a fatigue or stress mechanism Clinical Presentation: * History of acute or repetitive trauma to forefoot * Fracture type / pattern closely related to injury location * Foot often swollen, ecchymotic, very tender to fifth metatarsal +/- crepitus, inability to hear weight Diagnosis: * Clinical exam: * Evaluate skin integrity * Check neurovascular status * Evaluate toes/ feet/ ankles/ tib fib/ knees/ hips, involved tendon function, associated adjacent structures (Achilles, ankle ROM/ function, etc) * 3 XR views: lateral, anteroposterior, 45* oblique * Acute stress fractures are typically not detected on the standard 3 views; therefore, repeat XRs 10-14d after onset of sx (may see radiolucent reabsorption gap around fracture) * For more complex mid foot trauma, consider CT to r/o Lisfranc Treatment: * Consider classification of fracture, patient demographics & activity level when deciding on treatment * Tertiary care centers that have access to Orthopedics/Podiatry services * Consider consultation for “true” Jones fractures, as some cases may be operatively managed acutely and/or for expedited follow-up to be arranged * If working in community/rural locations: other than patients that present with “open” injuries, concerns for compartment syndrome (almost never), and “high-end”/professional athletes, there are generally no other circumstances that would require expedited transfer to a tertiary care center for immediate further evaluation. * Less favorable outcomes associated with certain patient factors: female gender, DM, obesity