Fractures Of Fore Foot PDF

FRACTURES OF FORE FOOT Objective: Overview of fractures Forefoot fracture a) Metatarsal fracture Fracture of head neck base and shaft of 5th metatarsal. Jones fracture Stress fracture Avulsion fracture Categories of Bone Fractures Bone fractures can be split into four main categories: Displaced...

FRACTURES OF FORE FOOT Objective: Overview of fractures Forefoot fracture a) Metatarsal fracture Fracture of head neck base and shaft of 5th metatarsal. Jones fracture Stress fracture Avulsion fracture Categories of Bone Fractures Bone fractures can be split into four main categories: Displaced Fracture This is where bone snaps into two or more pieces, and these pieces are not aligned with each other. Non-Displaced Fracture In this fracture, the bone can crack or break either partially or completely, but it maintains the correct alignment and does not shift. Closed Fracture This is where a bone breaks but does not result in an open wound in the skin or puncturing of the skin with the broken bone. Open Fracture In this case, the fracture causes the broken bone to poke through the skin. This category of fracture is serious because it leaves the bone vulnerable to a deep bone infection. Overview of fracture:  Biomechanics Metatarsal heads in contact with floor 60- 80% of stance phase Toes in contact with floor 75% of stance phase Mechanisms; Industrial accidents MVA Indirect (twisting injuries) Other Physical Examination 1.Gross deformity 2.Dislocations 3.Sensation 4.Capillary refill 5.Foot Compartments. Fracture of metatarsal: Mechanism: Due to compression injury to the foot area involved in the neck or shaft UNDISPLACED FRACTURE DISPLACED FRACTURE Neck of metatarsal The bone is in alignment. Treatment; May need reduction to Little treatment prevent pain developing in MT Head 4 to 6 month A short leg walking cast, fracture Manipulation is sometimes boot hard sole sandals may be effective preferable. ORIF is necessary  First MTP Dislocations Jahss, F&A, 1980 Type I: Hallux dislocation without disrupting sesamoid MT incarcerated by conjoined tendons and intact sesamoid Treatment : Open reduction required (dorsal, plantar, or medial approach) Type II: Disruption of intersesamoid ligament (type A) Transverse fracture of one of the sesamoids (type B) Treatment: Usually stable after reduction Treatment usually conservative and symptomatic (hard shoe for 4-6 weeks) FRACTURE OF BASE OF STYLOID OR 5TH FRACTURE OF SHAFT OF METATARSAL 5TH METATARSAL Are common Especially proximal Results from inversion injury diaphysis Usually undisplaced and require little Treatment: treatment Heals slowly requires Treatment: short leg casting for 6 to Light compression dressing and hard 8 weeks soled sandals are sufficient. Crutches necessary for 7 to 10 days Delayed union Healing 5 to 6 weeks Surgery (Left) X-ray shows a Jones fracture at the base of the fifth metatarsal (arrow). (Right) An intramedullary screw has been used to hold the bone in place while it heals Fracture of phalanges: Fracture of toe are common Requires little treatment Undisplaced fracture: Displaced Treated with buddy taping fracture: Can reduced without For 3 to 4 weeks to allow anesthesia union. Rarely open reduction. However proximal phalanx of great toe requires reduction accurately Dislocation of toe: Interphalangeal Or MTP dislocation are common usually results due to hyper-extension. Reduction usually easy following digital blocks Longitudinal traction is applied and dislocation is manipulated Post reduction radiographs are taken Buddy taping for 4 week to prevent recurrence. Left) In this X-ray, a recent stress fracture in the third metatarsal is barely visible (arrow). (Right) Several weeks later, there is callus formation at the site and the fracture can be seen more clearly. (Left) In this X-ray, a fracture in the proximal phalanx of the fifth toe (arrow) has caused the toe to become deformed. (Right) The bones in the angled toe have been manipulated (reduced) back into place X-ray shows an avulsion fracture at the base of the Fracture in the shaft of the 2nd metatarsal Stress fifth metatarsal (arrow). fracture Your fifth metatarsal has three zones along its length, starting from the base near the middle of your foot and extending out toward your toes. These zones tell your healthcare provider specific details about exactly where you broke your fifth metatarsal. Zone 1: The base of your metatarsal, where it joins the rest of your foot. Breaks in this zone are called avulsion fractures, dancer fractures, pseudo-Jones fractures or tennis fractures. These breaks are usually treated without surgery and heal in around two months after wearing a boot or cast. Zone 2: The middle part of your fifth metatarsal meets the base of Zone 1. If Zone 1 is the “head” of your fifth metatarsal, Zone 2 is the “body” extending out from it, further away from the middle of your foot. Fractures in Zone 2 are Jones fractures. Jones fractures usually require surgery, and have higher risks for complications than other types of foot fractures. Zone 3: The part of your fifth metatarsal that connects to your toe bones. Fractures in Zone 3 are usually stress fractures that take longer to heal and sometimes require surgery. Long term complication of digital fracture of lower limb Fractures in the toes or other parts of the lower limb can lead to several long-term complications if not treated properly. Here are some potential issues to be aware of: Chronic Pain: Reduced Range of Motion: Stiffness or limited movement in the toe or foot joint may result from scar tissue formation, joint damage, or improper alignment. Deformity: Misalignment or improper healing can lead to deformities such as hammertoe (where the toe is bent in a fixed position) or malunion (where the bone heals incorrectly). Arthritis: Damage to the joints from the fracture can increase the risk of developing arthritis in the affected area, leading to chronic pain, swelling, and decreased function. Functional Impairment: Long-term issues with walking or balance might arise if the fracture affects the weight-bearing structures of the foot or if there’s significant joint damage. Nerve Damage: Severe fractures may damage nerves in the area, leading to Osteomyelitis: Infections in the bone (osteomyelitis) can occur, particularly if the fracture is open and exposed to bacteria. Compartment Syndrome: Though less common in toes, severe cases of swelling or bleeding can lead to compartment syndrome, which is a serious condition requiring immediate medical intervention. Gait Changes: Long-term changes in gait or walking patterns can result from a digit fracture, potentially leading to additional stress on other parts of the lower limb and contributing to issues such as knee, hip, or back pain. Development of Bunion or Hammer Toe: Misalignment or improper healing can contribute to the development of bunions or hammer toe deformities over time