Page 132 - ASOP Orthopedic Casting Manual

3.3.4 Fracture Type(s) for Short Leg

Cast

Metatarsal Fractures
✓ Clinic al Relevant Anatomy: The metatarsals are five long bones loc ated in the midfoot, connecting the tarsal

bones to the phalanges. They play a cr itic al role in weight-be ar ing, b alance, and propulsion dur ing walking
and running. The first metatarsal is the thickest and strongest, be ar ing the most weight, while the fifth
metatarsal is more susceptible to avulsion fractures due to its attachment to the peroneus brevis tendon
LMoore et al., 2020M. Blood supply to the metatarsals is pr imar ily der ived from the dorsalis pedis and plantar
ar ter ies, with the nutr ient ar ter ies supplying the midshaft. Insufficient vascular ization, p ar ticular ly at the
proximal fifth metatarsal LJones fracture site), c an imp air he aling.
✓ Epidemiology / Etiology / Mechanism of Injur y: Metatarsal fractures are among the most common foot
fractures, accounting for approximately 35% of all foot fractures LCour t-Brown et al., 2021M. The fifth
metatarsal is the most frequently fractured, often due to t wisting injur ies, direct trauma, or stress-related
overuse; L1) high-energy trauma (e.g., falls, dropping he avy objects on the foot) c an le ad to displaced
fractures; L2M Repetitive stress in athletes and militar y personnel c auses stress fractures, commonly seen in
the second and third metatarsals LMarch fractures); L3M Twisting or inversion injur ies often c ause fifth
metatarsal avulsion fractures due to the pull of the peroneus brevis tendon.
✓ Clinic al Character istics / Presentation: Pain and swelling over the dorsum of the foot; Difficul t y walking or
be ar ing weight, especially with first and fifth metatarsal fractures; Loc alized tender ness, often at the fracture
site; Ecchymosis (bruising) around the midfoot or lateral border of the foot (especially in Jones fractures).
✓ Fracture Diagnosis Process: Physic al Examination: L1M Palp ation to loc alize p ain along e ach metatarsal; L2M
Assess for midfoot instabilit y if Lisfranc injur y is suspected; L3M Check for c apillar y refill and sensation to rule
out neurovascular compromise.
✓ Imaging Studies: L1M X-ray LAP, lateral, oblique views) to assess for fracture t ype and displacement; L2M MRI or
bone sc an in suspected stress fractures, where initial X-rays may be negative; L3M CT sc an if intra-ar ticular
ex tension is suspected.
✓ Differential Diagnosis / Associated Injur ies: Lisfranc injur y (midfoot instabilit y must be ruled out); Soft tissue
injur ies or ligamentous sprains mimicking fractures; Sesamoid fractures (common ne ar the first metatarsal
he ad).
✓ Tre atment / Management Considerations: L1M Nondisplaced fractures: Managed with an SLC or walking boot
for 4^6 weeks with progressive weight-be ar ing; L2M Stress fractures: Require activit y modific ation and
protective immobilization for 6^8 weeks; L3M Displaced fractures: May require closed reduction before c asting;
L4M Jones fractures (proximal fifth metatarsal fractures with high r isk of nonunion) may require operative
fixation LBucholz et al., 2021M.