A difference in millimeters of location can lead to a vastly different prognosis and treatment plan. What is the correct diagnosis in this patient?įractures of the proximal fifth metatarsal pose an important diagnostic challenge. Non-union is associated with pain, poor ambulation, and potential need for surgery.Ī 22-year-old man presents to the emergency department with foot pain after landing on his foot improperly while playing basketball last night. Athletes may be treated with intramedullary screw fixation. Zone 2 and 3 fractures are at high risk of complication, even with immobilization and non-weightbearing.Zone 1 fractures heal well, and patients can resume activities as tolerated.If unsure, treat as a Zone 2 or 3 injury: splint and ensure orthopedic follow up!. Zone 3: non-weightbearing for minimum 6 weeks, place in short leg posterior splint or boot, ensure orthopedic follow up within 1 week.Zone 2: non-weightbearing for minimum 6 weeks, place in short leg posterior splint or boot, ensure orthopedic follow up within 1 week.Zone 1: weightbearing as tolerated, hard-sole shoe or walking boot, 1-2 weeks of shoe/boot for comfort.Management revolves around specific diagnosis:.Provide analgesia and recommend elevation and ice for swelling.X-ray typically does not demonstrate a clean fracture line, but rather widened fracture site with cortical thickening. This fracture is associated with foot deformities and sensory neuropathy. Zone 3: Proximal diaphyseal fracture distal to 4 th-5 th metatarsal articulation.This is a vascular watershed area and is at high risk of non-union due to poor blood supply. Zone 2: Jones fracture is a fracture of the metaphysial-diaphysial junction, or 4 th-5 th metatarsal articulation.X-ray will show fracture line into metatarsocuboid joint. Result of bony fragment detachment by ligament. Zone 1: Pseudo-Jones fracture or avulsion involving the proximal tubercule.Obtain foot (AP, lateral, oblique) and ankle X-rays.Patients will meet criteria for imaging per Ottawa foot rules (pain at base of 5 thmetatarsal).Patients often have pain with weightbearing or are unable to bear weight. Present with pain, edema, bruising over lateral forefoot, with tenderness to palpation at the base of the 5th metatarsal.Patients often present with history of inversion, forefoot adduction, or chronic pain.
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