Fifth Metatarsal Injuries and Fractures Quiz

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Questions and Answers

Which ligamentous connection does the fifth metatarsal base NOT have?

Cuboid proximally

Navicular distally (correct)

Strong ligamentous attachments to both

Fourth metatarsal base medially

What is primarily responsible for the vascular supply of the fifth metatarsal?

Quadriceps venous supply

Dorsal and plantar metatarsal arteries (correct)

Anterior tibial artery

Thigh arteries

Which type of fracture is least associated with the fifth metatarsal neck?

Transverse fracture

Comminuted fracture

Complete fracture (correct)

Butterfly fragment fracture

What is a major concern regarding fractures at the base of the fifth metatarsal?

High incidence of tuberosity avulsion fractures Signup and view all the answers

What type of injury mechanism is primarily associated with fifth metatarsal avulsion fractures?

Inversion Signup and view all the answers

Which structure was traditionally thought to cause avulsion fractures of the fifth metatarsal?

Peroneus brevis tendon Signup and view all the answers

Which type of fracture is most likely to present with significant comminution?

Shaft fractures Signup and view all the answers

What has recent research implicated as a potential cause of fifth metatarsal avulsion fractures?

Lateral band of the plantar aponeurosis Signup and view all the answers

What is the primary goal of using external fixation in cases of significant comminution of the first metatarsal?

To maintain the length of the first metatarsal Signup and view all the answers

In the case of intra-articular first metatarsal head fractures, what is mandated if joint incongruity is noted?

Open reduction with internal stabilization Signup and view all the answers

Which of the following complications can arise from first metatarsal fractures?

Malunion and nonunion Signup and view all the answers

What treatment is typically indicated for nondisplaced or minimally displaced fractures of the central metatarsals?

Nonoperative treatment including protected mobilization Signup and view all the answers

Which technique may be employed in cases of significant impaction of metatarsal head fractures?

Cancellous bone grafting Signup and view all the answers

What aspect may influence the incidence of arthrosis following fractures involving joints?

Quality of reduction of joint surfaces Signup and view all the answers

In cases where solid fixation of a comminuted fracture at the metatarsal base cannot be accomplished, what method might a surgeon consider?

External fixation spanning the joints Signup and view all the answers

Why is it uncommon for nonunion to occur after a first metatarsal fracture?

High healing potential due to cancellous bone Signup and view all the answers

Which of the following surgical treatments is NOT mentioned for addressing nonunion of fractures?

Arthroscopic debridement Signup and view all the answers

What is a common complication associated with intramedullary screw fixation of fifth metatarsals?

Sural nerve irritation Signup and view all the answers

Which statement about the guidewire placement for intramedullary screw fixation is correct?

The guidewire should be advanced down the medullary canal without exiting any cortex. Signup and view all the answers

What anatomical feature should the guidewire ideally engage when entering the styloid process?

Both dorsal and medial cortex Signup and view all the answers

What is the recommended initial incision location for intramedullary screw fixation?

Proximal to the styloid process Signup and view all the answers

Which of the following is an important consideration during medullary curettage and bone grafting?

Lengthening the incision if medullary curettage is needed Signup and view all the answers

What should be ensured after placing the guidewire during the procedure?

The guidewire is confirmed to be along the entire length of the medullary canal. Signup and view all the answers

What is the purpose of assessing the alignment of the guidewire with fluoroscopy during surgery?

To confirm correct placement and avoid errors Signup and view all the answers

What complication is the most common after closed treatment of central metatarsal fractures?

Metatarsalgia secondary to malunion Signup and view all the answers

What is NOT a typical outcome when a nonunion occurs in a central metatarsal fracture?

Acute injury Signup and view all the answers

Which treatment method is commonly employed for managing central metatarsal fractures?

Dorsal plate fixation Signup and view all the answers

What is the likely reason for the low concern regarding nonunion in central metatarsal fractures?

Abundance of vascularity promoting healing Signup and view all the answers

In the context of fracture fixation, what technique may be particularly challenging for central metatarsal fractures?

Interfragmentary screw fixation Signup and view all the answers

What does disruption of the metatarsal parabola indicate in a clinical scenario?

Arthrosis at the first tarsometatarsal joint exists Signup and view all the answers

What type of fractures are described as potentially amenable to interfragmentary screw fixation?

Oblique or spiral oblique fractures Signup and view all the answers

What factor primarily contributes to the maintenance of alignment in the third metatarsal during fracture fixation?

Surrounding musculature Signup and view all the answers

What is the most common type of metatarsal fracture?

Fifth metatarsal fractures Signup and view all the answers

Which factor is considered paramount for the treatment of first metatarsal fractures?

Anatomic alignment Signup and view all the answers

What kind of complications are little known regarding central metatarsal fractures?

Long-term complications Signup and view all the answers

Which metatarsal fractures have controversy regarding their proper treatment?

Junctional fifth metatarsal fractures Signup and view all the answers

What is a common outcome expected when surgical intervention is implemented for metatarsal fractures?

Good outcome Signup and view all the answers

What can disruption in the metatarsal parabola cause?

Undue discomfort Signup and view all the answers

Which metatarsal fractures are likely to be amenable to conservative treatment?

Fifth metatarsal fractures Signup and view all the answers

What is a concerning factor for central metatarsal fractures that must be monitored?

Extent of soft tissue damage Signup and view all the answers

What is the primary focus of the study mentioned by Konkel et al. in 2005?

Nonoperative treatment of fifth metatarsal fractures Signup and view all the answers

Which method is analyzed by Larson et al. in 2002 regarding Jones fractures?

Intramedullary screw fixation Signup and view all the answers

What was the main finding of Horst et al. in their 2004 study?

Torque resistance after intramedullary screw fixation Signup and view all the answers

What innovative fixation system did Nunley and Glisson propose for Jones fractures?

Charlotte Carolina Jones fracture system Signup and view all the answers

What aspect did Moshirfar et al. study in their 2003 investigation?

Fifth metatarsal tuberosity fracture fixation Signup and view all the answers

What conclusion was reached in the retrospective review of Lombardi et al. regarding the management of acute Jones fractures?

External fixation demonstrated strong efficacy Signup and view all the answers

What treatment option is evaluated by Sarimo et al. for fractures located in the junction of the proximal metaphysis and diaphysis of the fifth metatarsal?

Tension-band wiring Signup and view all the answers

Which fixation technique was investigated by Koslowsky et al. in their 2010 study on displaced proximal fifth metatarsal fractures?

One-step fixation technique Signup and view all the answers

What is the commonly acceptable level of angulation for fractures in the metatarsals?

Less than 10 degrees Signup and view all the answers

What plane experiences the least tolerance for displacement in metatarsal fractures?

Sagittal plane Signup and view all the answers

Which treatment method is generally appropriate for maintaining alignment in central metatarsal fractures?

Closed manipulation with potential for open reduction Signup and view all the answers

What complication can arise from transverse plane malalignment of the metatarsals?

Intermetatarsal neuroma Signup and view all the answers

In the context of closed manipulation for metatarsal fractures, what may be necessary if reduction is difficult to maintain?

Open reduction and fixation Signup and view all the answers

What is a common method used for percutaneous pinning in metatarsal fractures?

Intramedullary pinning through the metatarsal head Signup and view all the answers

What specific detail is crucial for healing in metatarsal fractures?

Metatarsal parabola and bone-to-bone contact Signup and view all the answers

What is typically the common outcome when treating central metatarsal fractures surgically?

Minimal complications and good functional outcome Signup and view all the answers

What percentage of third metatarsal fractures also involves adjacent metatarsals?

63% Signup and view all the answers

Which ligament stabilizes the second metatarsal along with the cuneiform bones?

Lisfranc ligament Signup and view all the answers

What is the primary mechanism of injury leading to central metatarsal fractures?

Indirect torsional trauma Signup and view all the answers

Why can the first metatarsal move independently from the second metatarsal?

Lack of ligamentous support Signup and view all the answers

What distinguishes the fifth metatarsal's anatomical features from the central metatarsals?

Presence of a proximal tuberosity Signup and view all the answers

What type of forces primarily cause fractures in the central metatarsals?

Direct crushing forces Signup and view all the answers

In which part of the foot does the primary nutrient artery of the central metatarsals enter?

Laterally Signup and view all the answers

What percentage of all metatarsal fractures does the fifth metatarsal account for?

68% Signup and view all the answers

What was the mean time to return to activity for the failure group after metatarsal fractures?

6.8 weeks Signup and view all the answers

What size of cannulated screws was primarily used in the patients who sustained refractures?

4.0 mm Signup and view all the answers

Which factors are considered when selecting the appropriate size of screw for metatarsal fractures?

Patient size and activity levels Signup and view all the answers

What is the minimum duration of normal weight-bearing activity required before any exercise activity may commence after a fracture?

6 to 8 weeks Signup and view all the answers

What complication did the study by Mologne and colleagues find to be significantly lower in the surgical group compared to the casting group?

Treatment failure Signup and view all the answers

What is the typical screw size used when the medullary canal allows for a larger size?

4.5 mm Signup and view all the answers

What complication may arise from the use of excessively long screws during surgery?

Medial cortex penetration Signup and view all the answers

Which surgical method has become the most common treatment for junctional fractures of the fifth metatarsal?

Intramedullary screw fixation Signup and view all the answers

What has increased caution regarding the use of computed tomographic (CT) evaluation for fractures?

Concerns about increased exposure to radiation Signup and view all the answers

Which size screw is occasionally used in smaller patients with lower activity levels?

4.0 mm Signup and view all the answers

What is a key finding regarding union rates following intramedullary screw fixation for fifth metatarsal fractures?

100% satisfaction rate reported Signup and view all the answers

How many threads should ideally be engaged in the inner cortices of the bone during screw fixation?

At least three threads Signup and view all the answers

What percentage of casting patients in Mologne's trial were considered treatment failures?

44% Signup and view all the answers

What is a significant concern when selecting screw size for a patient with an unusually curved metatarsal?

Medial cortex penetration Signup and view all the answers

What type of treatment might still be necessary in cases with complete medullary obliteration?

Bone grafting Signup and view all the answers

What outcome is typically associated with using intramedullary screw fixation as opposed to casting for fractures?

Decreased healing times Signup and view all the answers

What is a common healing approach for a nondisplaced fifth metatarsal neck fracture?

Weight-bearing ambulation in a fracture boot Signup and view all the answers

Which complication is least likely to occur with metatarsal fractures that do not involve articulations?

Arthritis Signup and view all the answers

What complication is associated with the surgical intervention of fifth metatarsal fractures?

Issues with the sural nerve Signup and view all the answers

What is a significant risk when using dorsal incision placement for metatarsal surgeries?

Superficial nerve damage Signup and view all the answers

What type of surgical fixation is considered less common for fifth metatarsal fractures?

Plate fixation Signup and view all the answers

What outcome might be expected as a result of malunion in fifth metatarsal fractures?

Transfer metatarsalgia Signup and view all the answers

What is typically easier to address: prevention of complications or treatment after they arise?

Complication prevention Signup and view all the answers

Which type of metaphyseal injury could necessitate surgical intervention or revision surgery?

Delayed union or nonunion Signup and view all the answers

What is a common characteristic of the fifth metatarsal fractures in terms of treatment?

Most can be managed conservatively. Signup and view all the answers

What does disruption in the metatarsal parabola primarily signify?

Potential for undue discomfort. Signup and view all the answers

Why is anatomic alignment critical for the first metatarsal?

It contributes significantly to overall foot function. Signup and view all the answers

Which type of metatarsal fracture is known to have the highest chance of union?

Isolated central metatarsal fractures. Signup and view all the answers

What is a significant risk factor associated with junctional fifth metatarsal fractures?

Lack of standardized treatment protocols. Signup and view all the answers

In the management of metatarsal fractures, which approach has shown to yield good outcomes when surgical intervention is necessary?

Thorough preoperative assessment and planning. Signup and view all the answers

What can be a potential long-term consequence of improper treatment for metatarsal fractures?

Decreased foot function. Signup and view all the answers

What characterizes the treatment of central metatarsal fractures compared to other types?

Less standardization and consensus. Signup and view all the answers

What is a distinguishing feature between Jones fractures and proximal diaphyseal stress fractures?

Jones fractures are caused by acute trauma. Signup and view all the answers

In children, what anatomical structure can sometimes be confused with a fifth metatarsal fracture?

Apophysis Signup and view all the answers

Which radiographic feature indicates a fracture with delayed union?

Widening of the fracture line Signup and view all the answers

What role does the lateral band of the plantar aponeurosis play in fifth metatarsal fractures?

It typically results in larger fracture fragments compared to the peroneus brevis. Signup and view all the answers

What is the likely cause of an acute-on-chronic injury in the fifth metatarsal?

An existing stress reaction followed by a traumatic event. Signup and view all the answers

How can the presence of prodromal symptoms assist in diagnosis?

They can mislead the diagnosis towards a stress fracture. Signup and view all the answers

Which factor is critical in distinguishing acute injuries from chronic fractures in imaging?

Fracture line characteristics Signup and view all the answers

What potential pathology can be indicated by signs of a chronic fracture despite an acute injury?

Previous stress reaction or fracture Signup and view all the answers

What factor is crucial for maintaining the alignment of the first metatarsal during treatment?

Anatomic alignment Signup and view all the answers

What is the most common type of metatarsal fracture that occurs?

Fifth metatarsal fractures Signup and view all the answers

What type of complications are little known concerning central metatarsal fractures?

Extensive complications Signup and view all the answers

What is the consequence of disruption in the metatarsal parabola?

Undue discomfort Signup and view all the answers

What treatment method is most likely employed for patients with nondisplaced fractures of the central metatarsals?

Conservative treatment Signup and view all the answers

Which metatarsal fracture type still exhibits controversy regarding standard treatment approaches?

Fifth metatarsal fractures Signup and view all the answers

What outcome can patients and surgeons typically expect when surgical intervention is required for metatarsal fractures?

A good overall outcome Signup and view all the answers

What anatomical feature contributes to the overall function of the foot and is thus important to align properly during metatarsal treatment?

The metatarsal parabola Signup and view all the answers

What is a common complication following surgical intervention for fifth metatarsal fractures?

Infection at the incision site Signup and view all the answers

In evaluating the stability of a Jones fracture, which fixation method has shown varied outcomes based on screw size?

Cannulated screw fixation Signup and view all the answers

Which anatomical structure is critical for the proper healing of proximal fifth metatarsal fractures?

The peroneus brevis tendon Signup and view all the answers

Which characteristic of the Jones fracture typically complicates its treatment?

The susceptibility to nonunion Signup and view all the answers

What is cited as a significant factor influencing surgical outcomes for athletes with fifth metatarsal fractures?

Time to surgery after injury Signup and view all the answers

What type of imaging is crucial for accurately diagnosing complications in fifth metatarsal fractures?

Computed tomography (CT) Signup and view all the answers

During the assessment of fifth metatarsal fractures, what factor is considered critical in determining the surgical approach?

Fracture displacement Signup and view all the answers

What is a common anatomical variation that may affect the treatment of fractures in the fifth metatarsal?

Presence of accessory bones Signup and view all the answers

What is the maximum tolerable displacement in any plane for metatarsal fractures?

3 or 4 mm Signup and view all the answers

In which plane is displacement the least tolerated for metatarsal fractures?

Sagittal plane Signup and view all the answers

What is a potential consequence of dorsally angulated fractures?

Dorsal or transfer irritation at adjacent metatarsals Signup and view all the answers

What technique is commonly used for closed manipulation of central metatarsal fractures?

Distal traction Signup and view all the answers

Which of the following is NOT a common treatment for maintaining reduction in metatarsal fractures?

External fixation on all fractures Signup and view all the answers

What is a major challenge when using distal traction for closed manipulation of significant fractures?

Maintaining reduction can be futile Signup and view all the answers

What characteristic is often used to determine the treatment goal for metatarsal fractures?

The curvature of the metatarsal parabola Signup and view all the answers

What complication might arise from transverse plane malalignment of metatarsal fractures?

Intermetatarsal neuroma due to irritation Signup and view all the answers

What complication is most commonly associated with closed treatment of metatarsal fractures?

Delayed union Signup and view all the answers

What was the primary finding regarding the treatment of acute Jones fractures in the randomized controlled clinical trial mentioned?

Early screw fixation significantly reduced treatment failures. Signup and view all the answers

What is a major advantage of tension band fixation compared to other fixation methods for fifth metatarsal fractures?

It affords solid fixation without risking fracture of the fragment. Signup and view all the answers

What is the recommended duration of normal weight-bearing activity before exercise can begin post-fracture?

6 to 8 weeks Signup and view all the answers

When is surgical intervention typically warranted for a fifth metatarsal fracture?

When angulation is greater than 10 degrees. Signup and view all the answers

What characteristic of the fifth metatarsal shaft complicates interfragmentary fixation?

The relative fragility of the bone during fixation. Signup and view all the answers

What surgical treatment is currently most commonly performed for junctional fractures?

Intramedullary screw fixation Signup and view all the answers

What are the outcomes reported after intramedullary screw fixation for fifth metatarsal fractures?

Lower incidence of nonunion Signup and view all the answers

What was demonstrated to be a significant finding in the cadaveric study comparing lag screw fixation to intramedullary screw fixation?

Lag screw fixation provided a greater load to failure. Signup and view all the answers

What caution is recommended regarding the use of CT evaluations before implementing athletic activity?

Increased radiation exposure Signup and view all the answers

Which condition can typically be tolerated more easily in the fifth metatarsal compared to other metatarsals?

Shortening of the metatarsal shaft. Signup and view all the answers

What is a known risk associated with larger screws when fixing avulsion fractures of the fifth metatarsal?

Potential fracture of the bone fragment. Signup and view all the answers

What treatment outcome was observed for the cast group in the comparison study of Jones fracture treatments?

44% treatment failures Signup and view all the answers

In cases of nonunion or delayed union treated surgically, what additional procedure may still be performed?

Bone grafting Signup and view all the answers

In the evaluation of fifth metatarsal fractures, what factors should be assessed to determine the severity?

Amount of displacement and any angulation or shortening. Signup and view all the answers

What characteristic is commonly observed in the fracture pattern of the fifth metatarsal shaft?

Spiral fracture pattern possibly with butterfly fragments. Signup and view all the answers

What is the most common location for fractures of the fifth metatarsal?

At the base Signup and view all the answers

Which factor is believed to contribute to the slow healing of Jones fractures?

Proximity of the nutrient artery to the fracture Signup and view all the answers

What has shifted in recommendations for treating Jones fractures in active populations?

Surgical intervention is recommended for both elite and active populations Signup and view all the answers

In conservative treatment of Jones fractures, which approach is typically employed?

Protected mobilization in a CAM boot Signup and view all the answers

What mechanical issue contributes to the occurrence of stress fractures in the fifth metatarsal area?

High mobility due to strong attachments Signup and view all the answers

What factor is primarily responsible for the maintenance of alignment in central metatarsal fractures?

Adjacent musculature and vascularity Signup and view all the answers

Which patient population has traditionally been recommended surgical treatment for Jones fractures?

Elite athletes Signup and view all the answers

What is the most common complication that can arise from closed treatment of central metatarsal fractures?

Metatarsalgia due to malunion Signup and view all the answers

What is often the initial conservative management for a Jones fracture?

Protected immobilization in a CAM boot Signup and view all the answers

What location in the fifth metatarsal is noted for having a limited vascular supply?

Metaphyseal-diaphyseal junction Signup and view all the answers

Why might nonunion be rarely a concern in central metatarsal fractures?

Inherent stability due to vascular supply Signup and view all the answers

Which surgical fixation technique is typically used for central metatarsal fractures?

Dorsal plate fixation Signup and view all the answers

In the case of central metatarsal fractures, what may indicate a delayed union?

Stress fracture history Signup and view all the answers

What characterizes oblique or spiral oblique metatarsal fractures?

Amendable to interfragmentary screw fixation Signup and view all the answers

What anatomical change is noted in cases of metatarsal parabola disruption?

Sagittal plane malalignment Signup and view all the answers

What can lead to the cause of a second metatarsal fracture following tarsometatarsal joint arthrosis?

Forefoot dysfunction caused by joint changes Signup and view all the answers

What percentage of third metatarsal fractures occurred concurrently with fractures of the second or fourth metatarsals?

63% Signup and view all the answers

What type of trauma is most commonly attributed to central metatarsal fractures?

Direct trauma Signup and view all the answers

Which metatarsal is recognized for having a proximal tuberosity for tendon insertion?

Fifth metatarsal Signup and view all the answers

Which ligament provides stabilization to the second metatarsal?

Lisfranc ligament Signup and view all the answers

What is the most frequently fractured metatarsal?

Fifth metatarsal Signup and view all the answers

What is the primary source of blood supply to the central metatarsals?

Lateral nutrient artery Signup and view all the answers

In relation to the motion of the first and second metatarsal, what characterizes their function?

They operate independently of each other. Signup and view all the answers

What is a characteristic feature of central metatarsal fractures regarding soft tissue and joint stability?

They display a level of intrinsic stability with soft tissue attachments. Signup and view all the answers

What is the primary concern when managing Jones fractures at the base of the fifth metatarsal?

Potential for delayed healing Signup and view all the answers

Which characteristic distinguishes acute fractures of the fifth metatarsal from stress fractures?

Recent trauma history Signup and view all the answers

What factor could contribute to nonunion in fractures of the first metatarsal?

Misalignment of fracture fragments Signup and view all the answers

Which biomechanical feature of the fifth metatarsal is crucial for understanding its fracture types and treatment approaches?

Angle of the metatarsal parabola Signup and view all the answers

Which of the following conditions is often monitored when treating central metatarsal fractures?

Reestablishment of the metatarsal parabola Signup and view all the answers

In the context of surgical treatment for fifth metatarsal fractures, what complication is most commonly associated with intramedullary screw fixation?

Malunion of the fracture Signup and view all the answers

What classification pertains to fractures of the base of the fifth metatarsal?

Jones versus acute fractures Signup and view all the answers

What methodology can be crucial in evaluating the alignment of the guidewire during surgical fixation?

Fluoroscopy Signup and view all the answers

What is the typical expected outcome when conservative treatment is applied to fractures of the fifth metatarsal?

Healing usually occurs without surgical intervention. Signup and view all the answers

Which statement is accurate regarding the first metatarsal's anatomical significance?

Proper alignment is essential for optimal foot function. Signup and view all the answers

What potential outcome may arise from neglecting disruption in the metatarsal parabola?

Increased risk of chronic discomfort. Signup and view all the answers

What characterizes central metatarsal fractures in terms of healing?

They are generally associated with a high chance of union. Signup and view all the answers

Which aspect complicates the treatment of junctional fifth metatarsal fractures?

Lack of consensus among medical professionals. Signup and view all the answers

Which factor is most likely to contribute to long-term complications after a metatarsal fracture?

Disruption of the metatarsal parabola. Signup and view all the answers

What is a common characteristic of the fifth metatarsal fractures?

A significant portion can be treated conservatively. Signup and view all the answers

What does the literature suggest about the variety of attitudes toward metatarsal fractures treatment?

Different specialists hold varying opinions on management strategies. Signup and view all the answers

What is the primary concern when managing a Jones fracture of the fifth metatarsal?

Risk of nonunion Signup and view all the answers

Which fixation method has been evaluated as a common treatment for acute Jones fractures?

Intramedullary screw fixation Signup and view all the answers

What common complication arises from surgical fixation of fifth metatarsal fractures?

Malunion Signup and view all the answers

During the assessment of a proximal fifth metatarsal fracture, which anatomical consideration is crucial?

Engagement of the styloid process Signup and view all the answers

What aspect is particularly challenging when treating displaced proximal fifth metatarsal fractures?

Achieving fixation stability Signup and view all the answers

What is an innovative fixation system proposed for managing Jones fractures?

Cannulated screw system Signup and view all the answers

What tends to be a preferred treatment option for nondisplaced fractures of the fifth metatarsal?

Conservative management Signup and view all the answers

Which study analyzed early screw fixation versus casting in the treatment of Jones fractures?

Mologne et al. 2005 Signup and view all the answers

What is the commonly acceptable level of translation for metatarsal fractures?

3 to 4 mm Signup and view all the answers

What is the least tolerated plane for displacement in metatarsal fractures?

Sagittal plane Signup and view all the answers

Which technique is commonly used for pinning when maintaining fracture reduction is challenging?

Intramedullary pinning with a single K-wire Signup and view all the answers

What is a common complication that can arise from close abutment of the metatarsal heads?

Intermetatarsal neuroma Signup and view all the answers

What is a critical concern with dorsally angulated fractures?

Dorsal irritation at the adjacent metatarsals Signup and view all the answers

Which feature is essential to ensure healing occurs in metatarsal fractures?

Proper bone-to-bone contact Signup and view all the answers

In what scenario may percutaneous pinning be warranted?

With significant vascular compromise Signup and view all the answers

What typically makes frontal plane malalignment less of a concern in metatarsal fractures?

Uncommon occurrence of displacement Signup and view all the answers

What defines a Jones fracture in terms of its anatomical location?

A transverse fracture at the metaphyseal-diaphyseal junction Signup and view all the answers

Which factor is noted as a possible predisposing condition for Jones fractures?

Hindfoot varus attitude Signup and view all the answers

What typical complication is associated with fractures at the base of the first metatarsal?

Traumatically induced hallux limitus/rigidus Signup and view all the answers

What mechanism is commonly associated with Jones fractures?

Large adduction force while the ankle is plantar flexed Signup and view all the answers

What is a significant consequence of considerable displacement in first metatarsal fractures?

Deterioration of hallux function at the metatarsophalangeal joint Signup and view all the answers

What feature is commonly evaluated in the case of nonunion of central metatarsal fractures?

Alignment and stabilization of the metatarsal parabola Signup and view all the answers

Why must treatment of first metatarsal fractures be approached with strict attention to detail?

Significant forces traverse this bone during walking Signup and view all the answers

What might be observed on a radiograph that indicates previous injury before a metatarsal fracture?

Bony callus formation Signup and view all the answers

What is a significant disadvantage of percutaneous pinning techniques for metatarsal fractures?

Limited ability to directly visualize and manipulate the fracture Signup and view all the answers

What is the purpose of dorsiflexing the toe during minimally invasive surgical procedures for metatarsal fractures?

To provide access for guided pinning Signup and view all the answers

What anatomical feature is primarily disrupted when using percutaneous intramedullary fixation methods?

Metatarsophalangeal joint Signup and view all the answers

What advantage does standard open reduction with internal fixation provide over minimally invasive methods?

Complete anatomic reduction with easier visualization Signup and view all the answers

Minimally invasive techniques for metatarsal fractures aim to achieve which of the following?

Direct visualization and manipulation without extensive stripping Signup and view all the answers

What is an essential consideration when deciding on a surgical approach for metatarsal fractures?

The degree of fracture displacement and instability Signup and view all the answers

Which surgical technique may involve a risk of disrupting the soft tissue envelope around the fracture site?

Standard open reduction with internal fixation Signup and view all the answers

What is a primary reason for the potential long-term risks associated with the described surgical methods?

The potential for flexor tendon injury Signup and view all the answers

What was the failure cycle count for the cannulated titanium screw in the study comparing different screw types?

4308 cycles Signup and view all the answers

Which type of screw showed the highest strength according to the comparison study involving different screw types?

Noncannulated stainless steel screw Signup and view all the answers

What was the mean time to return to activity in the failure group after treatment?

6.8 weeks Signup and view all the answers

What was the general recommendation for treating fifth metatarsal fractures when time to return to full activities is not critical?

Non-operative treatment Signup and view all the answers

Which factor is NOT mentioned as significant when determining screw size for fixation?

Type of fracture Signup and view all the answers

Which type of screw was specifically developed for Jones fracture fixation, according to one study?

Carolina screw Signup and view all the answers

What diameter screw is most commonly used when appropriate in fixation for metatarsal fractures?

5.0 mm Signup and view all the answers

What was a major finding regarding the number of cycles to failure and screw size in the study conducted by Reese and colleagues?

Strength increased with increasing screw size Signup and view all the answers

What complication has been reported in patients experiencing refracture after intramedullary screw fixation?

Refracture Signup and view all the answers

What complication was noted in the study by Larson and colleagues regarding intramedullary screw fixation for Jones fractures?

Refracture and nonunion Signup and view all the answers

What was the reported failure rate of intramedullary screw fixation in elite athletes, according to Larson and colleagues?

83% Signup and view all the answers

Why might a solid screw be preferred over a cannulated screw in certain cases?

Improve screw engagement Signup and view all the answers

What was a significant finding related to screw size used in high-demand patient populations?

Larger screws may prevent failure Signup and view all the answers

Which of the following screws exhibited the lowest cycle to failure according to the study by Reese and colleagues?

Cannulated titanium screw Signup and view all the answers

What characteristic must all threads of the screw ideally achieve relative to the fracture site?

All threads should be distal to the fracture site Signup and view all the answers

What consideration is essential to prevent the screw from penetrating the medial cortex?

Length of the screw Signup and view all the answers

Which fixation technique is considered effective for treating Jones fractures according to Reese et al. in 2004?

Cannulated screw fixation Signup and view all the answers

What aspect did Horst et al. investigate in their 2004 study regarding the treatment of Jones fractures?

Torque resistance after fixation with intramedullary screws Signup and view all the answers

What innovative system did Nunley and Glisson introduce for the treatment of Jones fractures?

Charlotte Carolina Jones fracture system Signup and view all the answers

Which treatment method is utilized by Sarimo et al. for fractures located in the junction of the proximal metaphysis and diaphysis of the fifth metatarsal?

Tension-band wiring Signup and view all the answers

Which complication is noted in studies regarding intramedullary screw fixation of the fifth metatarsals?

Malunion Signup and view all the answers

What fixation technique was proposed by Koslowsky et al. in their 2010 study for displaced proximal fifth metatarsal fractures?

One-step fixation technique Signup and view all the answers

What clinical outcome is primarily assessed by Moshirfar et al. in their 2003 study related to fifth metatarsal tuberosity fractures?

Biomechanical stability of fixation methods Signup and view all the answers

What finding was highlighted in the retrospective review by Lombardi et al. regarding the management of acute Jones fractures?

Higher rates of non-union with conservative treatment Signup and view all the answers

What percentage of all foot fractures are represented by acute metatarsal fractures?

35% Signup and view all the answers

Which type of metatarsal fractures can be associated with Lisfranc dislocations?

Proximal metaphyseal fractures Signup and view all the answers

Which type of injury mechanism is primarily responsible for most metatarsal fractures?

Low-energy trauma Signup and view all the answers

Which fractures should be evaluated for shortening, angulation, and displacement?

Diaphyseal fractures Signup and view all the answers

What is a common concern with high-energy crush injuries related to metatarsal fractures?

Soft tissue envelope condition Signup and view all the answers

Which fracture type may progress from a stress fracture to a complete transverse fracture?

Diaphyseal fractures Signup and view all the answers

For fifth metatarsal fractures, which is a likely reason for the low concern regarding nonunion?

Efficient bone healing Signup and view all the answers

What type of metatarsal fracture is noted to typically occur in patterns of transverse or oblique fractures?

Distal metaphyseal fractures Signup and view all the answers

What contributes to the slow healing tendency of Jones fractures?

Disruption of the major blood supply Signup and view all the answers

Which treatment method is commonly recommended for conservative management of Jones fractures?

Protected mobilization in a CAM boot Signup and view all the answers

What anatomical feature poses a risk for motion at the fracture site when weight is applied?

The strong ligamentous attachments at the fifth metatarsal base Signup and view all the answers

In which population is surgical treatment of Jones fractures typically recommended?

Elite athletes and other active populations Signup and view all the answers

Which statement accurately describes the vascular supply of the fifth metatarsal base?

The nutrient artery enters from the medial aspect near the fracture site. Signup and view all the answers

What influence does the metaphyseal-diaphyseal junction have on Jones fractures?

It is prone to a limited vascular supply. Signup and view all the answers

Which factor is considered when determining treatment for active individuals with Jones fractures?

Duration of immobilization Signup and view all the answers

How does weight-bearing activities affect the fifth metatarsal during healing?

It exacerbates motion at the fracture site. Signup and view all the answers

What is the incidence rate of first metatarsal fractures in adults?

1.5% of all metatarsal fractures Signup and view all the answers

What main advantage do cannulated screws offer in the fixation of fifth metatarsal fractures?

Easier application due to guidewire advancement Signup and view all the answers

Which characteristic of the first metatarsal contributes to its strength and stability?

It is the thickest and heaviest of the metatarsals. Signup and view all the answers

Which type of screw demonstrated the highest number of cycles to failure in the comparisons made?

Noncannulated stainless steel screw Signup and view all the answers

What is a common mechanism of fracture for the first metatarsal in pediatric populations?

Falls from height. Signup and view all the answers

What was a significant concern raised in the comparison of cannulated screws versus solid screws?

Strength of the screws under stress Signup and view all the answers

What role does the articular surface of the first metatarsal play?

It allows for articulation with the medial cuneiform and phalanges. Signup and view all the answers

In the treatment failures reported by Larson and colleagues, what commonality existed among the patients affected?

All were elite athletes Signup and view all the answers

What factor was shown to increase the number of cycles to failure in screw fixation?

Size of the screw utilized Signup and view all the answers

What effect can a traumatic injury to the first metatarsal have on gait?

It can cause pain at the first metatarsophalangeal joint and disturb gait. Signup and view all the answers

What outcome was NOT typically reported following intramedullary screw fixation for Jones fractures?

Successful union in all cases Signup and view all the answers

Which of the following statements regarding the first metatarsal is inaccurate?

Fractures of the first metatarsal are common in all age groups. Signup and view all the answers

Which screw type was reported to exceed other options with regard to load cycles by a significant margin?

4.5-mm Carolina screw Signup and view all the answers

What is the primary feature of the first metatarsal's head?

It is covered entirely by articular cartilage. Signup and view all the answers

Which anatomical feature is significant for the first metatarsal's articulation with the medial cuneiform?

A large kidney-shaped articular surface. Signup and view all the answers

What is the primary issue associated with the use of cannulated screws compared to solid screws?

Lower strength and durability Signup and view all the answers

What typically characterizes the management of unstable distal fractures of the first metatarsal?

Surgical intervention is usually necessary Signup and view all the answers

What is a primary concern when dealing with fractures of the first metatarsal?

Potential loss of length affecting normal metatarsal curvature Signup and view all the answers

What is the suggested duration for non-weight bearing treatment following a nondisplaced first metatarsal fracture?

2 to 3 weeks Signup and view all the answers

Which fixation technique is considered standard for diaphyseal fractures of the first metatarsal?

Buttress plating with screw fixation Signup and view all the answers

What should be prioritized during the fixation of a first metatarsal fracture?

Restoration of bony apposition and osseous architecture Signup and view all the answers

In which scenario is close radiographic follow-up particularly emphasized?

Nondisplaced fractures to maintain alignment Signup and view all the answers

What common issue often arises due to significant displacement in the transverse plane of the first metatarsal?

Onset of hallux valgus Signup and view all the answers

What anatomical feature is crucial to consider during the fixation of the first metatarsal fracture?

The presence of sesamoid bones beneath the first metatarsal Signup and view all the answers

Which type of injury mechanism is primarily associated with the Jones fracture of the fifth metatarsal?

Indirect violence through ankle inversion Signup and view all the answers

What is the primary concern regarding vascular supply in the healing of fifth metatarsal fractures?

Inadequate intraosseous blood supply leading to delayed healing Signup and view all the answers

What is the classification of a fracture at the base of the fifth metatarsal distal to the tuberosity primarily based on?

The specific location of injury on the metatarsal Signup and view all the answers

Which type of fracture is least likely to result in significant comminution in metatarsal injuries?

Fifth metatarsal avulsion fractures Signup and view all the answers

In which case may a surgical intervention be deemed necessary for fifth metatarsal fractures?

Displaced fractures with significant misalignment Signup and view all the answers

Which anatomical feature is critical for understanding the healing implications of proximal fractures in the fifth metatarsal?

The location of the tuberosity on the bone Signup and view all the answers

What is a significant complication associated with closed treatment of central metatarsal fractures?

Nonunion leading to chronic pain Signup and view all the answers

What is a common finding in biomechanical studies on fifth metatarsal fractures?

Distinct biomechanical patterns associated with different fracture types Signup and view all the answers

Which of the following levels of angulation is commonly accepted as acceptable for metatarsal fractures?

10 degrees Signup and view all the answers

Sagittal plane displacement of fractures is the least tolerated.

True Signup and view all the answers

What is the main goal of treatment for metatarsal fractures?

To maintain a functional forefoot. Signup and view all the answers

Closed manipulation of fractures of the central metatarsals can be done with __________.

distal traction Signup and view all the answers

Match the plane of malalignment to its tolerance level in metatarsal fractures:

Sagittal plane = Least tolerated Transverse plane = Better tolerated Frontal plane = Not typically a concern Signup and view all the answers

What condition can arise due to close abutment of the metatarsal heads?

Intermetatarsal neuroma Signup and view all the answers

Dorsally angulated fractures do not cause irritation at the adjacent metatarsals.

False Signup and view all the answers

Percutaneous Kirschner (K)-wire pinning is often performed through the corresponding metatarsal head using a __________ fixation.

single K-wire Signup and view all the answers

What percentage of third metatarsal fractures occurred concurrently with second or fourth metatarsal fractures?

63% Signup and view all the answers

All cases of multiple metatarsal fractures can occur in non-contiguous bones.

False Signup and view all the answers

Which metatarsal is reported to be the most frequently fractured?

fifth metatarsal Signup and view all the answers

The second metatarsal is additionally stabilized by the _______ ligament.

Lisfranc Signup and view all the answers

Match the following metatarsals with their unique features:

First Metatarsal = Independent motion due to lack of ligamentous connection Fifth Metatarsal = Proximal tuberosity for peroneus brevis tendon Second Metatarsal = Stabilized by Lisfranc ligament Third Metatarsal = Commonly associated with second or fourth fractures Signup and view all the answers

What kind of trauma is most commonly associated with central metatarsal fractures?

Direct trauma Signup and view all the answers

Direct trauma to the foot can include crushing blows and penetrating injuries.

True Signup and view all the answers

What is the primary nutrient artery's entry point for the central metatarsals?

laterally, approximately 3.1 cm from the distal articular cartilage Signup and view all the answers

What was the mean time to return to activity in the failure group?

6.8 weeks Signup and view all the answers

A smaller screw size is always appropriate for high-demand patient populations.

False Signup and view all the answers

How many refractures occurred in the study after intramedullary screw fixation?

6 Signup and view all the answers

The appropriate-sized screw used is typically a , , or mm screw.

4.5-, 5.0-, or 5.5- Signup and view all the answers

Match the following screws to their characteristics:

Cannulated screw = Hollow with a central canal Solid screw = No central canal 4.0 mm screw = Used in smaller patients with less activity 6.5 mm screw = Can cause metatarsal shaft breakage Signup and view all the answers

What factor is crucial when selecting an appropriate-sized screw?

The size of the medullary canal Signup and view all the answers

It is important for all threads of a screw to be distal to the fracture site.

True Signup and view all the answers

What type of patients sustained refractures in the study?

Professional football players, collegiate basketball player, recreational athlete Signup and view all the answers

What is the primary goal when treating a fifth metatarsal fracture?

Maintaining a normal metatarsal parabola Signup and view all the answers

Tension band fixation is preferred over larger screws in treating avulsion fractures of the fifth metatarsal.

True Signup and view all the answers

What type of injury is primarily responsible for avulsion fractures of the styloid process?

Inversion type of injury Signup and view all the answers

What is the typical non-surgical management period for fifth metatarsal fractures?

4 to 5 weeks Signup and view all the answers

Avulsion fractures of the styloid process tend to heal well.

True Signup and view all the answers

What is a common treatment for nondisplaced or minimally displaced avulsion fractures?

Immobilization in a weight-bearing CAM boot Signup and view all the answers

The technique that resulted in greater load to failure in fixing the fifth metatarsal was __________.

lag screw fixation Signup and view all the answers

Match the fracture types with their characteristics:

Spiral fracture = Typically presents with rotational force Butterfly fragment fracture = Involves a wedge-shaped fragment Comminuted fracture = Characterized by multiple shattered pieces Signup and view all the answers

Fractures involving more than ______ mm of displacement should be considered for surgical intervention.

2 Signup and view all the answers

When is surgical intervention recommended for fifth metatarsal fractures?

When displacement is greater than 3 to 4 mm Signup and view all the answers

Match the following treatments with their corresponding fracture types:

Immobilization = Nondisplaced avulsion fractures Screw fixation = Displaced avulsion fractures Excision = Small portion of styloid process fractures Percutaneous fixation = Minimally displaced fractures Signup and view all the answers

Which of the following is a recommended method of fixation for significant displacement in avulsion fractures?

Intramedullary screw fixation Signup and view all the answers

Interfragmentary screw fixation is always a suitable option for fifth metatarsal fractures.

False Signup and view all the answers

Identify a common complication associated with fifth metatarsal fractures.

Fracture of the fragment Signup and view all the answers

The insertion site of the peroneus brevis tendon is usually expansive enough to require tendon anchoring in all avulsion fractures.

False Signup and view all the answers

What complications should be monitored for fractures involving 30% or more of a joint?

Surgical intervention may be needed Signup and view all the answers

What is the primary treatment method for nondisplaced fifth metatarsal neck fractures?

Weight-bearing ambulation in a fracture boot Signup and view all the answers

Delayed union and nonunion can lead to a need for surgical intervention.

True Signup and view all the answers

What type of surgical fixation is less commonly performed for fifth metatarsal fractures?

Plate fixation Signup and view all the answers

Complications from metatarsal fractures can include __________.

arthritis Signup and view all the answers

Match the complication of fifth metatarsal fractures with its description:

Delayed union = Extended time away from activity Nonunion = Fracture that has failed to heal Malunion = Improper alignment of the healing bone Nerve issues = Potential damage to surrounding nerve structures Signup and view all the answers

Which of the following is a potential consequence of malunion in a metatarsal fracture?

Transfer metatarsalgia Signup and view all the answers

What can cause irritation to the sural nerve during surgical intervention of a fifth metatarsal fracture?

Incision placement Signup and view all the answers

Most metatarsal fractures involve articulations.

False Signup and view all the answers

What percentage of total skeletal fractures do metatarsal fractures account for?

5% Signup and view all the answers

Metatarsal fractures rarely occur due to direct trauma.

False Signup and view all the answers

What is the primary concern in high-energy crush injuries related to metatarsal fractures?

Soft tissue envelope Signup and view all the answers

Metatarsal fractures are commonly classified into proximal metaphyseal, diaphyseal, and ________ fractures.

distal metaphyseal Signup and view all the answers

Which location is NOT typically associated with metatarsal fractures?

Cervical Signup and view all the answers

Match the following types of metatarsal fractures with their characteristics:

Proximal metaphyseal = May be associated with Lisfranc dislocations Diaphyseal = Often oblique and evaluated for shortening Distal metaphyseal = Typically transverse or oblique Stress fractures = Can progress to complete transverse fractures Signup and view all the answers

Metatarsal fractures can only occur as isolated injuries.

False Signup and view all the answers

What type of metatarsal fractures are often well aligned due to articulations and soft tissue attachments?

Proximal metaphyseal and metatarsal base fractures Signup and view all the answers

The first metatarsal is the longest, strongest, and heaviest of the metatarsal bones.

False Signup and view all the answers

In which population is a higher rate of first metatarsal fractures noted?

Pediatric populations Signup and view all the answers

The first metatarsal articulates with the medial ____________.

cuneiform Signup and view all the answers

Match the types of metatarsal fractures with their characteristics:

Nondisplaced fracture = A fracture where bones remain aligned Stress fracture = A fracture caused by repetitive stress Comminuted fracture = A fracture consisting of three or more pieces Diaphyseal fracture = A fracture along the length of a bone Signup and view all the answers

What is a common outcome associated with a traumatic disruption of the first metatarsal?

Pain at the first metatarsophalangeal joint Signup and view all the answers

The first metatarsal is covered by articular cartilage at both ends.

True Signup and view all the answers

What is the primary injury mechanism for fractures in pediatric populations under 5 years?

Fall from a height Signup and view all the answers

Which metatarsal fracture is most commonly associated with conservative treatment?

Fifth metatarsal Signup and view all the answers

Central metatarsal fractures are known for having extensive complications.

False Signup and view all the answers

What is paramount regarding the treatment of first metatarsal fractures?

Anatomic alignment Signup and view all the answers

The ______ metatarsal is the most common type of metatarsal fracture.

fifth Signup and view all the answers

Match the following types of metatarsal fractures to their key characteristics:

Central metatarsal = High chance of union, low complication Fifth metatarsal = Most commonly fractured First metatarsal = Important for foot function Junctional fifth metatarsal = Controversy in treatment Signup and view all the answers

What consequence can disruption in the metatarsal parabola cause?

Undue discomfort Signup and view all the answers

Surgical intervention for metatarsal fractures do not typically lead to good outcomes.

False Signup and view all the answers

What is one significant factor that influences the treatment approach to metatarsal fractures?

Patient population Signup and view all the answers

What is the typical conservative treatment for Jones fractures?

Protected mobilization in a CAM boot Signup and view all the answers

Jones fractures tend to heal quickly with minimal complications.

False Signup and view all the answers

What is the most commonly encountered metatarsal fracture?

Fifth metatarsal fracture Signup and view all the answers

The base of the fifth metatarsal has strong ligamentous attachments to the and .

cuboid, fourth metatarsal base Signup and view all the answers

Which patient population is commonly recommended for surgical treatment of Jones fractures?

Elite athletes Signup and view all the answers

Match the following factors to their roles in the healing of Jones fractures:

Nutrient artery proximity = Potential disruption of blood supply Metaphyseal-diaphyseal junction = Limited vascular supply Strong ligamentous attachments = Increased motion at fracture site Signup and view all the answers

Weight-bearing activities can negatively impact healing in fractures at the fifth metatarsal.

True Signup and view all the answers

What duration of non-weight bearing is typically recommended for conservative treatment in Jones fractures?

6 to 8 weeks Signup and view all the answers

Which type of screw has been shown to have the greatest strength in the studies referenced?

Noncannulated stainless steel screw Signup and view all the answers

Cannulated screws are preferred because they provide better strength than noncannulated screws.

False Signup and view all the answers

What is the recommended treatment option for patients with fifth metatarsal fractures when time to return to activities is not critical?

Non-operative treatment Signup and view all the answers

The ___ screw exceeded the load cycles compared to other screws by up to 7067-fold.

4.5-mm Carolina Signup and view all the answers

What issue was observed with screw fixation methods for Jones fractures?

Treatment failures documented in patients Signup and view all the answers

Match the type of screw with its corresponding description:

Cannulated screws = Easier application and adjustment Noncannulated screws = Higher strength and cycles to failure 4.5-mm Carolina screw = Specific for Jones fracture fixation Solid screws = Traditionally used for more stable fixation Signup and view all the answers

The study by Reese and colleagues demonstrated that larger screw sizes had no effect on the number of cycles to failure.

False Signup and view all the answers

In the studies reviewed, what percentage of treatment failures occurred in elite athletes?

83% Signup and view all the answers

What is the primary focus of the study conducted by Kavanaugh et al. in 1978 regarding the Jones fracture?

Management strategies for Jones fractures Signup and view all the answers

The study by Mologne et al. indicated that early screw fixation is less effective than casting for Jones fractures.

False Signup and view all the answers

Name one potential complication following intramedullary screw fixation of fifth metatarsal fractures.

Nonunion Signup and view all the answers

The anatomical feature that should engage during the guidewire placement for intramedullary screw fixation is the ______ process.

styloid Signup and view all the answers

Match the following authors with their studies related to metatarsal fractures:

DeLee J = Stress fracture of the fifth metatarsal Porter D = Jones fracture fixation techniques Wright R = Refracture after treatment Zogby R = Nonoperative treatment of Jones’ fracture Signup and view all the answers

Which of the following is NOT a treatment option mentioned for Jones fractures?

Open reduction and internal fixation Signup and view all the answers

Stress fractures of the fifth metatarsal are commonly observed in athletes.

True Signup and view all the answers

What does the term 'Jones fracture' refer to?

Fracture of the proximal fifth metatarsal Signup and view all the answers

What percentage of all foot fractures do acute metatarsal fractures account for?

35% Signup and view all the answers

Most metatarsal fractures are caused by high-energy trauma.

False Signup and view all the answers

What is the main concern with high-energy crush injuries related to metatarsal fractures?

Compartment syndrome Signup and view all the answers

Metatarsal fractures are generally divided into _____, diaphyseal, and head and neck fractures.

proximal metaphyseal Signup and view all the answers

Which fractures may be associated with Lisfranc dislocations?

Proximal metaphyseal fractures Signup and view all the answers

Match the type of metatarsal fracture with its common fracture pattern:

Proximal metaphyseal = Well aligned due to soft tissue Diaphyseal = Often oblique Distal metaphyseal = Typically transverse or oblique Stress fracture = May progress to complete transverse fracture Signup and view all the answers

Compartment syndrome is not a concern for metatarsal fractures.

False Signup and view all the answers

What do distal metaphyseal fractures typically experience if displacement is present?

Plantarly and laterally Signup and view all the answers

What is the common surgical treatment for acute fifth metatarsal fractures?

Intramedullary screw fixation Signup and view all the answers

Early screw fixation has a higher treatment failure rate compared to casting for acute Jones fractures.

False Signup and view all the answers

What is the purpose of a computed tomographic (CT) evaluation before implementing athletic activity?

To ensure complete healing and decrease the chance of refracture. Signup and view all the answers

The common complication following closed treatment of metatarsal fractures is __________.

nonunion Signup and view all the answers

Match the treatment options with their related outcomes:

Intramedullary screw fixation = Lower incidence of refracture Casting = Higher treatment failure rate Bone grafting = Used when nonunion is present CT evaluation = Assures complete healing Signup and view all the answers

What percentage of patients in the casting group experienced treatment failures according to the study?

44% Signup and view all the answers

Caution is recommended with the routine use of CT due to increased radiation exposure concerns.

True Signup and view all the answers

What factors are assessed clinically before implementing exercise activity after a fracture?

Lack of pain with direct palpation and signs of trabeculation crossing the fracture. Signup and view all the answers

What was the highest number of cycles to failure recorded for a solid screw in the compared studies?

7067-fold increase Signup and view all the answers

Cannulated screws are stronger than solid screws based on the cycles to failure reported.

False Signup and view all the answers

What type of fixation is commonly used for fifth metatarsal fractures?

intramedullary screw fixation Signup and view all the answers

The strength of the cannulated titanium screw failed after ______ cycles.

4308 Signup and view all the answers

Match the types of screws with their reported cycles to failure:

Cannulated titanium screw = 4308 cycles Cannulated stainless steel screw = 22012 cycles Noncannulated stainless steel screw = 44523 cycles Solid screw = 27-fold to 7067-fold increase Signup and view all the answers

What was a significant outcome reported by Larson and colleagues regarding intramedullary screw fixation?

Failures occurred in 6 of 15 patients. Signup and view all the answers

The size of screws used in intramedullary fixation ranged from 3.5 mm to 5.0 mm.

False Signup and view all the answers

What percentage of failures in screw fixation occurred among elite athletes?

83% Signup and view all the answers

What type of fracture is associated with avulsion of the styloid process?

Avulsion fracture Signup and view all the answers

Avulsion fractures of the styloid process tend to have a poor healing tendency.

False Signup and view all the answers

What is the recommended treatment for nondisplaced and minimally displaced fractures?

Immobilization in a weight-bearing CAM boot Signup and view all the answers

In cases of more than __ mm of displacement, surgical intervention should be considered.

2 Signup and view all the answers

What should be done when displacement occurs in an avulsion fracture?

Open reduction with internal fixation Signup and view all the answers

Match the following terms related to avulsion fractures with their definitions:

Peroneus brevis tendon = Causes avulsion fractures at the styloid process Inversion injury = Type of injury associated with avulsion fractures Weight-bearing CAM boot = Treatment for nondisplaced fractures Screw fixation = Method of stabilizing displaced fractures Signup and view all the answers

Nondisplaced avulsion fractures require tendon anchoring during treatment.

False Signup and view all the answers

What is one common method of fixation mentioned for displaced avulsion fractures?

Intramedullary screw fixation Signup and view all the answers

What percentage of fifth metatarsal fractures is reported to occur?

68% Signup and view all the answers

The second metatarsal does not articulate with any cuneiform bones.

False Signup and view all the answers

What is the major cause of central metatarsal fractures?

Direct trauma Signup and view all the answers

The fifth metatarsal has a proximal tuberosity for the insertion of the _______ tendon.

peroneus brevis Signup and view all the answers

Match the metatarsals with their unique features:

Second Metatarsal = Articulates with all three cuneiform bones Fifth Metatarsal = Has a proximal tuberosity First Metatarsal = Functions independently Central Metatarsals = Stable proximal articulations Signup and view all the answers

What type of injury is primarily associated with indirect fractures of the central metatarsals?

Twisting Signup and view all the answers

The first metatarsal has a strong ligamentous support connecting it to the second metatarsal.

False Signup and view all the answers

What anatomical structures primarily stabilize the bases of the central metatarsals?

Plantar, dorsal, and interosseous ligaments Signup and view all the answers

Which type of metatarsal fracture is acknowledged as the most common?

Fifth metatarsal fracture Signup and view all the answers

Central metatarsal fractures are associated with a high likelihood of union.

True Signup and view all the answers

What is primarily crucial for the treatment of first metatarsal fractures?

Anatomic alignment Signup and view all the answers

The fifth metatarsal has a high percentage of fractures that can be treated with ________ treatment.

conservative Signup and view all the answers

Which aspect can potentially cause discomfort if disrupted in the metatarsal?

Metatarsal parabola Signup and view all the answers

Match the fracture type with its treatment approach:

First metatarsal fracture = Anatomic realignment Fifth metatarsal fracture = Conservative treatment Central metatarsal fracture = Excellent chance of union Comminuted metatarsal fracture = Surgical intervention Signup and view all the answers

Controversy exists around the treatment of junctional fifth metatarsal fractures.

True Signup and view all the answers

What causes significant inconvenience to patients with metatarsal fractures?

Pain and limited mobility Signup and view all the answers

Study Notes

Metatarsal Fractures

Metatarsal fractures are a common cause of forefoot pain, representing 35% of all foot fractures and 5% of total skeletal fractures.
Fractures may be isolated, concurrent with other metatarsal fractures, or associated with Lisfranc injuries.
Direct or indirect trauma can cause metatarsal fractures, though high-energy crush injuries are also possible. These injuries have a primary concern for the soft tissue envelope, requiring compartment syndrome evaluation before osseous intervention.
Metatarsal fractures are categorized by location: proximal metaphyseal, diaphyseal (shaft), and head/neck.
Proximal metaphyseal and base fractures often remain relatively stable due to supporting soft tissues and articulations.
Diaphyseal fractures are usually oblique, needing evaluation for shortening, angulation, and displacement.
Distal metaphyseal fractures are commonly transverse or oblique, often displacing plantarly and laterally.
The first metatarsal is the thickest, strongest, shortest, and heaviest metatarsal. It's less frequently fractured in adults (1.5% incidence) but more frequently in children. Lower energy trauma is the usual cause.
High-energy fractures require prioritizing soft tissue envelope health over immediate osseous treatment.
Metatarsal fractures, especially those involving the fifth metatarsal, may be associated with fractures in other central metatarsals. Fractures are often contiguous.
Careful radiographic assessment is important in case of isolated fractures, as contiguous fractures are common.
Avulsion fractures can occur at the base of the first metatarsal due to plantar flexion and inversion injuries related to peroneus longus and tibialis anterior attachments.
Intramedullary screw fixation, with considerations for size, avoiding penetration of the medial cortex, and appropriate screw placement, is sometimes used.
The goal of treatment is to maintain a functional forefoot, considering the metatarsal parabola, the sagittal plane position of metatarsal heads, and bone to bone contact.
Special consideration should be given to fractures involving the first metatarsal, central metatarsals, and the fifth metatarsal, as their unique anatomical and functional characteristics may necessitate different treatment approaches.

First Metatarsal

First metatarsals are crucial for function and gait.
A disruption in their integrity can lead to gait disturbances affecting the entire limb, including the medial column, first metatarsophalangeal joint and the lesser metatarsals.
Pain may be presented in the first metatarsophalangeal joint or proximally along the medial column, or at the lesser metatarsals, or, in severe cases, the entire limb.
Because of unique function and commonality with central metatarsals, first, central, and fifth metatarsals should be examined separately. This evaluation is important for potential gait disturbance and maintaining functional forefoot mobility.
The first metatarsal has a large, kidney-shaped articular surface for the medial cuneiform.
The head is completely covered by articular cartilage for its articulation with the proximal phalanx distally, and the sesamoids plantarly. Articulations are important for normal function.
The first metatarsal is supplied by the dorsal, plantar, and medial plantar metatarsal arteries, commonly originating from the first dorsal artery.
The first metatarsal's anatomy, including the size of the medullary canal, and patient activity should be factored into the selection of fixation options. The anatomy and function of the first metatarsal need to be considered when planning treatment.
Displacement in the sagittal plane of the first metatarsal is less well tolerated than longitudinal plane displacement. This can impact the hallux and lead to gait problems.
Metatarsalgia can occur if there is malalignment, nonunion, or malunion and affects the function of the forefoot, midfoot, and entire limb.
Screw size, overdrilling of the bone, and proper screw placement should be considered in intramedullary screw fixation.

Central Metatarsals

Multiple metatarsal fractures are common, often involving contiguous bones.
Radiographic assessment is important when considering isolated metatarsal fractures due to the high likelihood of additional involvement.
Central metatarsals are stabilized by plantar, dorsal, and interosseous ligaments, with the tibialis posterior being the only extrinsic attachment.
The shafts of these metatarsals serve as origins for intrinsic plantar and dorsal interossei muscles.
Injury is caused by indirect torsional or direct trauma such as a crushing blow to the dorsum of the foot, or twisting.
The primary nutrient artery enters laterally, approximately 3.1 cm from the distal articular cartilage.
In cases of multiple metatarsal fractures, the most severely displaced fracture is often prioritized for reduction and stabilization, potentially eliminating the need for additional interventions for adjacent fractures.