Sports Related Fractures of the Foot and Ankle Patrick Ebeling, MD Orthopedic Foot and Ankle Surgeon Twin Cities Orthopedics Burnsville, MN No disclosures
Sports Related Fractures of 5 th Metatarsal Fractures the Foot and Ankle Patrick Ebeling, MD Orthopedic Foot and Ankle Surgeon Twin Cities Orthopedics Burnsville, MN
Anatomy
Pathophysiology Inversion injury Associated ankle sprain Most common sports Basketball etc
Risk Factors Cavus/cavovarus foot Ankle instability?fall risk? Picture of peek a boo sign
Proximal Avulsion Fracture Proximal tubercle fracture Avulsed by lateral band of plantar fascia Fracture is proximal to the insertion of the peroneus brevis Picture of of 5 th MT avulsion
Proximal Avulsion Fracture Treatment Usually non-surgical 4 weeks WBAT in a boot Indications for surgery Significant displacement Articular extension Painful non-union Picture of of 5 th MT avulsion fixed
The Mimic Proximal apophysis of 5 th metatarsal Can have fracture associated with this Iselin s disease Usually closes by 14 Often non-surgical mgmt Picture of bug that looks like stick
Jones Fracture Described by Sir Robert Jones when he suffered the injury himself Metaphyseal-diaphyseal junction fracture Why don t they want to heal? Insertion of P. Brevis Nutrient artery Picture Robert Jones X-ray of Jones fracture
Jones Fracture Non-surgical Treatment Indications Non-displaced Poor surgical candidate Low demand Short leg cast NWB 6 weeks Evaluate for associated ankle ligament injury X-ray of short leg cast
Jones Fracture Surgical Treatment Indications Any displacement Cavus foot deformity Athlete/high demand Recurrent fracture Non-union Cavus foot correction Recurrent fracture Severe deformity X-ray of IM fixation of Jones fx Picture of Dwyer
Jones Fracture Surgical Treatment Post-op NWB 6 weeks Short leg cast 2 weeks Aircast boot 4-6 weeks ROM after 2 weeks Evaluate for associated ankle ligament injury Picture of standing on sidelines with crutches
Shaft Fractures Dancer s Fracture Long, oblique fracture Twisting injury Non-surgical healing can be slow Surgical indications Patient preference Non-union Athlete/high demand X-ray of dancer s fracture
Other Shaft Fractures More likely to need surgical treatment X-ray of comminuted shaft fracture
Stress Fractures Appropriate history X-ray characteristics Sclerosis Hypertrophic Treatment Generally surgical Requires bone grafting Correct foot alignment X-ray of stress fracture
Bibliography Thevendran G, Deol R, Calder J. Fifth Metatarsal Fractures in the Athlete: Evidence for Management. Foot Ankle Clinics NA 18:237-254; 2013. Smith TO, Clark A, Hing CB. Interventions for Treating Proximal Fifth Metatarsal Fractures in Adults: A Meta-analysis of the Current Evidence-base. Foot and Ankle Surgery 17:300-07; 2011. Polzer H, Polzer S, Mutschler W, Prall W. Acute Fractures to the Proximal Fifth Metatarsal Bone: Development of Classification and Treatment Recommendations Based on the Current Evidence. Injury 43:1626-32; 2012. Roche A, Calder J. Treatment and Return to Sport Following a Jones Fracture of the Fifth Metatarsal: A Systematic Review. Knee Surg Sports Traumatol Arthrosc 21:1307-15; 2013.
Bibliography Mallee W, Weel H, van Dijk CN, Tulder M, Kerkhoffs G, Lin C. Surgical Versus Conservative Treatment for High-Risk Stress Fractures of the Lower Leg (Anterior Tibial Cortex, Navicular and Fifth Metatarsal Base): A Systematic Review. Br Jl Sports Med 49:370-6; 2015. Solan M, Davies M. Nonunion of Fifth Metatarsal Fractures. Foot Ankle Clin NA 19:499-519; 2014. Nagar M, Forrest N, Maceachern C. Utility of Follow-up Radiographs in Conservatively Managed Acute Fifth Metatarsal Fractures. Foot 24:17-20;2014. Hyu B, Preston J, Queen R, Byram I, Hardaker W, Gross M, Davis JM, Taft T, Garrett W. Effects of Wearing Foot Orthosis with Medial Arch Support on the Fifth Metatarsal Loading and Ankle Inversion Angle in Selected Basketball Tasks. Jl Ortho & Sports PT 37:186-191; 2007.