5th met fracture

Question 1

What is a 5th met fracture?

Answer 1

-Fracture that occurs at the base of 5th met
-Three types: Avulsion, Jones or Stress
MOA
-PF and Ev of hind foot, avulsion proximal
-Forefoot adduction, jones intermediate
-repetitive trauma, stress distal

Question 2

What is the anatomy of the 5th met fracture?

Answer 2

Proximal to distal

• Tuberosity, base, metadiaphysis, diaphysis, neck and head
• metadiaphyseal region is a vascular water shed prone to non union
• os peroneum present near the tuberosity and lies in the tendon of peroneus brevis

Question 3

What are the clinical findings and test you would perform for 5th met fracture?

Answer 3

• recent increase in load
• Pain on lateral border of foot, worse when WB
• Tenderness to palpation in area
• Varus hindfoot, cavus forefoot
• Excessive lateral wear pattern on shoe treads
• callus 5th met head
• evaluate lig lax
• pain with resisted foot eversion indicates PB weakness

Question 4

What are some imaging your might order for diagnosis?

Answer 4

X-ray
-AP and Oblique view
look for periosteal, callus formation from fracture as well as fracture lines
CT
-better evaluation of fracture
MRI
-picks up oedema well in area for stress fracture

Question 5

What is the management for this condition?

Answer 5

• RICE
• Paracetamol
• compression bandage or strapping in area
• Protect and offload in cast, stiff sole shoe or boot, up to 8 weeks
• NWB in jones or stress fracture casts for 8 weeks
• consider surgery after if non union
• symptoms may be present up to 6 months
• footwear prescription
• orthotics
• strength and conditioning (physio)

Question 6

What are some strapping techniques or medications you would prescribe?

Answer 6

Ankle taping
-if pt plays or returns to sport

Paracetamol
-for pain relief