fifth metatarsal base fracture

zone 1 fractures or tuberosity fractures"pseudo-Jones fractures,":
zone 2 fractures - jones fractures
zone 3 fractures- stress fractures.
Tuberosity avulsion fractures occur during forced inversion of the foot and ankle.
This injury can occur as a result of stepping into a hole, twisting your foot during sports activities, or falling off a stair.
The cause of the injury is forceful contraction of the peroneus brevis and contracture of the lateral band of the plantar fascia.
A Jones fracture is caused by significant adduction force applied to the forefoot or due to a direct trauma.
Stress fractures of the fifth metatarsal result from chronic and repetitive microtrauma.
Pain and tenderness on the outside part of your foot.
Abrupt onset of pain following a distinct injury suggests an acute fracture.
on other hand the onset of the pain may be gradual and happen over a period of weeks or months. When this happens, it is usually considered a stress fracture.
Swelling on the outside part of your foot.
Discoloration or bruising on your foot.
Difficulty walking or bearing weight on your foot.
For patients in whom clinical suspicion for a fracture is high,but radiographs are negative,
we suggest the patient substantially limit activity and that plain radiographs be repeated in two weeks.
We reserve MRI for highly competitive athletes who are unwilling to reduce activity levels,
and patients in whom clinical suspicion remains high but follow-up radiographs at two weeks again fail to reveal any evidence of fracture.
a conservative treatment for nondisplaced avulsion fractures, or jones and stress nondisplaced fractures in recreational athlete or when the patients refuse the surgery.
the patient with zone 2 and 3 fractures must understand that the conservative management may take 20 weeks of period,
and the high risk of nonunion despite painstaking adherence to treatment guidelines.
and the possibility of subsequent need for surgery if nonoperative treatment fails.
A well-molded, short leg, nonweightbearing cast should be applied.
you should also receive standard cast instructions:
(to seek evaluation immediately for symptoms suggestive of a compartment syndrome).
elevation of the affected foot on pillows when lying down or sitting.
you can use medicines (NSAID) and muscle relaxants.
Three to five days postinjury, after swelling has begun to subside,
you should be seen in follow-up and a cast check.
radiographs may be repeated 2 weeks postinjury to assure the fracture remains nondisplaced.
you need not return for four to 6 weeks, unless a new symptom or cast problem necessitates an earlier visit.
After 6 to 8 weeks, you should have the cast removed and radiographs repeated.
If healing is noted, the cast may be discontinued, and rehabilitation begun.
If the fracture shows no evidence of healing, continuing conservative management for an additional four to six weeks is reasonable.
Don't be surprised if your foot is still swollen and discolored.
This is common after a 5th metatarsal base fractures.
Once healing is evident and the cast is removed, your doctor will refer you for physiotherapy.
you should begin progressive weightbearing and exercises to restore normal foot and ankle function.
Because of the risk of refracture, the patient should resume weightbearing very gradually.
you begin with partial weightbearing
(ie, placing most of his or her weight on crutches and only a small portion on the affected foot).
When the patient can walk comfortably with full weight on the foot
(roughly three to seven days after cast removal),
crutches may be discontinued.
you can return to full daily life activities including playing sports at 3-4 months if fracture site pain-free and signs of radiographic callus.
Displaced fractures,
or symptomatic non-union fractures,
you will be sent for surgery.
in jones and stress nondisplaced fractures the surgical treatment is preferred mor than nonsurgical treatment.
because it minimizes possibility of nonunion and refracture or prolonged restriction from activity.
surgery includes Intramedullary screw fixation which can be done percutaneously.
Open reduction internal fixation with plate and screw.
Open reduction internal fixation with k-wires and tension band wiring also has been described
After surgery, your foot will probably be put in a cast to help immobilize the fracture while it heals for 3 weeks.
it will usually be non-weightbearing cast, Therefore, you will most likely need crutches to walk.
when the cast is removed, gradual, progressive weightbearing should be begun.
and starting physiotherapy focusing on range of motion exercises.
it is normal for swelling to persist for some months after surgery and is completely normal.
This swelling will eventually completely subside with time
and can take up to 12 months
but often goes well before this.
you can return to full activities including playing sports at 6weeks post-surgery if fracture site pain-free and signs of radiographic callus.