Episode 165.0 – Foot Fractures - a podcast by Core EM

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

Hosts:

Audrey Bree Tse, MD

Brian Gilberti, MD







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







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Tags: Orthopedics











Show Notes

Episode Produced by Audrey Bree Tse, MD



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)





* 3 XR views: lateral, anteroposterior, 45* oblique

*  Acute stress fractures are typically not detected on the standard 3 views; therefore, repeat XRs 10-14d after onset of sx (may see radiolucent reabsorption gap around fracture)

* For more complex mid foot trauma, consider CT to r/o Lisfranc



Treatment:



* Consider classification of fracture, patient demographics & activity level when deciding on treatment

* Tertiary care centers that have access to Orthopedics/Podiatry services



* Consider consultation for “true” Jones fractures, as some cases may be operatively managed acutely and/or for expedited follow-up to be arranged





* If working in community/rural locations: other than patients that present with “open” injuries, concerns for compartment syndrome (almost never), and “high-end”/professional athletes, there are generally no other circumstances that would require expedited transfer to a tertiary care center for immediate further evaluation.

* Less favorable outcomes associated with certain patient factors: female gender, DM, obesity

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