Exam 2 Lecture 3 and 4 Metatarsal and Sesamoid Fractures Dr Smith Flashcards
what is the order of frequency of metatarsal fractures? (Which mets break more commonly?)
5,3,2,1,4
What type of fixation should be employed to fixate spiral fractures in the metatarsals?
Neutralization plates
Which radiographical plane is most important for metatarsal fractures?
Sagittal plane is most important dealing with dorsiflexion/plantarflexion.
What is the mechanism of action for metatarsal head fractures?
Direct trauma or impaction.
Often you will find transverse fractures in these instances.
What is the general mechanism of action for metatarsal shaft fractures?
Direct trauma, blunt force, and torsional injuries (spiral)
What imaging is best for observing metatarsal base fractures?
X-Ray!!
AND
CT!!!!!
Note the need for CT is unique here as most other metatarsal fractures only require X-ray.
what are the specific displacement measures that will tell you if you need to fixate a metatarsal fracture?
Any metatarsal that is displaced greater than 10 degrees of angulation or 3-4mm of displacement in the sagittal plane.
What is the name of an acute diaphyseal/metaphyseal fracture of the fifth metatarsal?
Jones Fracture
The stewart classification is used to describe….
Proximal diaphyseal stress fractures of the fifth metatarsal base.
What is a Type 1 Stewart Classification?
Fracture at the metaphyseal-diaphyseal junction.
this is a classic jones fracture.
What is a Type 2 Stewart classification?
Intra-articular fifth met tuberosity fracture without comminution
What is a type 3 Stewart Classification?
Extra-articular tuberosity fracture of the fifth met
What is a type 4 Stewart Classification?
Intra-articular, comminuted tuberosity fracture
What is a Type 5 Stewart Classification?
Fracture of the Epiphysis of the fifth metatarsal.
Avulsion fractures are always in which direction of the force being placed on the bone?
Always 90 degrees to the force or stress that is being created
How could one compare a stress fracture to the apophysis in a peds patient?
Fractures will always be 90 degrees to the deforming force where as apophysis are always paralel to the bone axis.
What does the torg Classification compare?
compares types of stress fractures!
Patient complains of pain after falling on the balls of the feet?
suspect possible sesamoid fracture.
Especially with pain on dorsiflexion.
How can you distinguish between a bipartite sesamoid and a fractured sesamoid?
Bipartite sesamoids are rounded.
fractures sesamoids generally have jagged edges. Typically also have longitudinal cracks.
Which of the two sesamoids are most commonly fractured?
The tibial sesamoid is fractured more commonly, is larger, and bears more weight.
What are the common fracture patterns of the sesamoids?
commonly transverse or comminuted fracture lines.
