A look at foot fractures – which can be splinted and which may need to go to the OR.


https://media.blubrry.com/coreem/content.blubrry.com/coreem/Foot_Fractures.mp3



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Tags: Orthopedics





Show Notes
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)