5th metatarsal fracture classification11/8/2023 ![]() Fractures to the body of the fifth metatarsal base are considered ‘base fractures’, and fractures distal to the body of the fifth metatarsal base are considered ‘metatarsal’ or diaphyseal fractures. There has also been 3 zones of fracture descrbed in metatarsal base fractures:įor our simplified classification, it is fractures that involve the styloid process that are considered true ‘avulsion’ fractures. Anything distal to that is a ‘metatarsal’ fracture. For instance, fractures that are within 1.5 cm to the end of the styloid process are considered an ‘avulsion’ fracture. In reviewing the literature, these ‘zones’ differ and some are delineated by distance from the end of the bone. There has been some debate and confusion as to the correct descriptions of fractures of the proximal fifth metatarsal. The injury is caused by stress plantarflexion and inversion. It was named after Sir Robert Jones, who in 1902, sustained this fracture while dancing around a maypole at a garden dance. The Jones fracture describes a fracture to the base of the fifth metatarsal. Where your scope of practice allows for modification to the requested views/anatomy, modify your technique to suit. This is an area where the radiographer must employ a patient-centred rather than a picture-centred approach to radiography- ask the patient about their mechanism of injury, examine the patient, and if there are any discrepancies between the patient's presentation and the requested imaging communicate your concerns with the referring doctor. Many referrers simply ask for ankle and foot radiography for all injuries involving ankle and/or foot. Patients who have clear clinical signs of a base of 5th metatarsal fracture (mechanism + localised swelling + localised pain) will sometimes be referred, in error, for ankle radiography. Referrals for ankle and foot radiography are often confused. When a patient presents with this degree of soft tissue swelling over the base of the 5th metatarsal, it is important to collimate the X-ray beam to include the 5th metatarsal on the ankle views, or perform separate foot views. As suggested by the clinical appearance, the patient had sustained a base of 5th metatarsal fracture. The radiographer noted clearly evident features of a 5th metatarsal fracture. This patient was referred for ankle radiography. The black arrow is pointing to the avulsion fracture.īase of 5th metatarsal fractures will often be characterised by overlying soft tissue swelling and localised pain. The characteristic features are the orientation of the lucent line (longitudinal oblique rather than transverse) and the rounded corners and sclerotic margins. The white arrow identifies the normal apophysis. His oblique foot image demonstrates 2 lucent lines resembling fractures at the base of the 5th metatarsal (arrowed). This 13 year old boy presented to the Emergency Department after an inversion injury to his left ankle while playing on a trampoline. Fractures of the Proximal Fifth Metatarsal The apophysis has an oblique orientation, with the radiolucency aligned parallel to the fifth metatarsal diaphysis. In girls nine to 11 years of age and boys 11 to 14 years of age, the apophysis becomes visible on plain radiographs as a fleck of calcification adjacent to the fifth metatarsal shaft. The development of a secondary center of ossification (apophysis) at the base of the fifth metatarsal can be mistaken radiographically as a fracture site. Similarly, the radiographer should also consider the possibility clinically and radiographically that the patient who is referred for ankle radiography following an inversion injury may have a base of 5th metatarsal avulsion fracture. The referring doctor should pay careful attention to the base of the 5th metatarsal when examining all patients presenting with a history of ankle inversion injury. The mechanism of injury and other clinical signs may suggest an ankle injury- indeed, there may be considerable pain and swelling associated with the ankle. ![]() The fracture results from an abnormally large tension force transmitted though the peroneus brevis tendon.īase of 5th metatarsal fractures present a potential trap for the referring doctor and radiographer alike. This page considers all aspects of plain film imaging of metatarsal fractures.īase of 5th metatarsal fractures deserve separate consideration based on their common occurrence and the specific mechanism of injury.įractures of the base of the 5th metatarsal are commonly tuberosity avulsion fractures caused by an inversion/plantar flexion injury of the ankle. ![]()
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