Exam 2 Lecture 3 and 4 Metatarsal and Sesamoid Fractures Dr Smith

Question 1

what is the order of frequency of metatarsal fractures? (Which mets break more commonly?)

Answer 1

5,3,2,1,4

Question 2

What type of fixation should be employed to fixate spiral fractures in the metatarsals?

Answer 2

Neutralization plates

Question 3

Which radiographical plane is most important for metatarsal fractures?

Answer 3

Sagittal plane is most important dealing with dorsiflexion/plantarflexion.

Question 4

What is the mechanism of action for metatarsal head fractures?

Answer 4

Direct trauma or impaction.

Often you will find transverse fractures in these instances.

Question 5

What is the general mechanism of action for metatarsal shaft fractures?

Answer 5

Direct trauma, blunt force, and torsional injuries (spiral)

Question 6

What imaging is best for observing metatarsal base fractures?

Answer 6

X-Ray!!

AND

CT!!!!!
Note the need for CT is unique here as most other metatarsal fractures only require X-ray.

Question 7

what are the specific displacement measures that will tell you if you need to fixate a metatarsal fracture?

Answer 7

Any metatarsal that is displaced greater than 10 degrees of angulation or 3-4mm of displacement in the sagittal plane.

Question 8

What is the name of an acute diaphyseal/metaphyseal fracture of the fifth metatarsal?

Answer 8

Jones Fracture

Question 9

The stewart classification is used to describe….

Answer 9

Proximal diaphyseal stress fractures of the fifth metatarsal base.

Question 10

What is a Type 1 Stewart Classification?

Answer 10

Fracture at the metaphyseal-diaphyseal junction.

this is a classic jones fracture.

Question 11

What is a Type 2 Stewart classification?

Answer 11

Intra-articular fifth met tuberosity fracture without comminution

Question 12

What is a type 3 Stewart Classification?

Answer 12

Extra-articular tuberosity fracture of the fifth met

Question 13

What is a type 4 Stewart Classification?

Answer 13

Intra-articular, comminuted tuberosity fracture

Question 14

What is a Type 5 Stewart Classification?

Answer 14

Fracture of the Epiphysis of the fifth metatarsal.

Question 15

Avulsion fractures are always in which direction of the force being placed on the bone?

Answer 15

Always 90 degrees to the force or stress that is being created

Question 16

How could one compare a stress fracture to the apophysis in a peds patient?

Answer 16

Fractures will always be 90 degrees to the deforming force where as apophysis are always paralel to the bone axis.

Question 17

What does the torg Classification compare?

Answer 17

compares types of stress fractures!

Question 18

Patient complains of pain after falling on the balls of the feet?

Answer 18

suspect possible sesamoid fracture.

Especially with pain on dorsiflexion.

Question 19

How can you distinguish between a bipartite sesamoid and a fractured sesamoid?

Answer 19

Bipartite sesamoids are rounded.

fractures sesamoids generally have jagged edges. Typically also have longitudinal cracks.

Question 20

Which of the two sesamoids are most commonly fractured?

Answer 20

The tibial sesamoid is fractured more commonly, is larger, and bears more weight.

Question 21

What are the common fracture patterns of the sesamoids?

Answer 21

commonly transverse or comminuted fracture lines.