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Monday, April 2, 2012

Fifth Metatarsal Fractures: Non Jones Type

These images are from a new patient I will see next week. She is almost 3 months post injury and her X-rays show a wide gap still. Here are all the thoughts that are meandering through my brain. 
Here is the standard Lateral view with quite a large gap noted 

A Jones Fracture to the Fifth Metatarsal is normally 1 inch closer to the toes. This AP view still shows some displacement.

This Oblique view makes the fracture clearer and you can see if goes into the joint of the 5th metatarsal cuboid. 

The fracture clearly goes across to the joint. 

     This 5th metatarsal avulsion fractures following some inversion twist of the foot are typically under treated. Because they do not have the stigma of a true Jones fracture (historically more serious), they can be less aggressively treated. Sometimes this is okay, and sometimes not. Again, the goal is to create a pain free environment, which I believe has happened. X-rays for foot fractures, since the healing normally takes place internally first, can not really reflect the strength of the bone. But, I do not like the gap and I do not like the fact that the joint is involved (possibly future arthritis). 

     So, what are all the steps we need to make happen? 

1) Establish a pain free environment if not already occurring

2) Make sure Bone Strength is good (questioning about VitD3 and Calcium, bone density, healthy diet)

3) Stabilize the fifth metatarsal with orthotic devices, accommodative padding, and kinesiotaping (there   are special techniques in orthotic devices for the outside of your foot)

4) Set workout goals that do not over stress this area

5) Avoid anti-inflammatories since they can slow down bone healing

6) Ice Pack 10 minutes twice daily, and contrast baths once daily to reduce inflammation

7) Due to the gap, seek approval for Exogen Bone stimulator

8) Have patient talk to a surgeon to find out what the process of fixing if the above does not work (well informed)

9) Advise on possible future arthritis

10) Only get future X-rays if treatment has plateaued (there are many cases of pain free non healing)


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