Essential Insights On Treating Fifth Metatarsal Fractures

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Continuing Education Course #140 — April 2006

I am pleased to introduce the latest article, “Essential Insights On Treating Fifth
Metatarsal Fractures,” in our CE series. This series, brought to you by the North American Center for Continuing Medical Education (NACCME), consists of regular CE activities that qualify for one continuing education contact hour (.1 CEU). Readers will not be required to pay a processing fee for this course.

The incidence of fifth metatarsal fracture is somewhat common in active patients and such fractures can be complicated in nature. With this in mind, Nicholas Romansky, DPM, and Todd Becker, DPM, provide an essential guide to classification systems for these types of fractures. They also review key diagnostic pearls and pertinent treatment considerations for facilitating optimal outcomes.

At the end of this article, you’ll find a 10-question exam. Please mark your responses on the enclosed postcard and return it to NACCME. This course will be posted on Podiatry Today’s Web site (www.podiatrytoday.com) roughly one month after the publication date. I hope this CE series contributes to your clinical skills.

Sincerely,

Jeff A. Hall
Executive Editor
Podiatry Today

INSTRUCTIONS: Physicians may receive one continuing education contact hour (.1 CEU) by reading the article on pg. 77 and successfully answering the questions on pg. 82. Use the enclosed card provided to submit your answers or log on to www.podiatrytoday.com and respond via fax to (610) 560-0502.
ACCREDITATION: NACCME is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
DESIGNATION: This activity is approved for 1 continuing education contact hour or .1 CEU.
DISCLOSURE POLICY: All faculty participating in Continuing Education programs sponsored by NACCME are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentation.
DISCLOSURE STATEMENTS: Drs. Romansky and Becker have disclosed that they have no significant financial relationship with any organization that could be perceived as a real or apparent conflict of interest in the context of the subject of their presentation.
GRADING: Answers to the CE exam will be graded by NACCME. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the exam.
TARGET AUDIENCE: Podiatrists.
RELEASE DATE: April 2006.
EXPIRATION DATE: April 30, 2007.
LEARNING OBJECTIVES: At the conclusion of this activity, participants should be able to:
• demonstrate a thorough knowledge of fifth metatarsal fractures;
• discuss common causes and diagnostic characteristics of cervical fractures, capital fractures and shaft fractures of the fifth metatarsal;
• review the Delee and Torg classification systems for Jones fractures;
• review key treatment considerations with Jones fractures; and
• discuss the diagnosis and treatment of tuberosity fractures of the fifth metatarsal.

Sponsored by the North American Center for Continuing Medical Education.

This is a spiral shaft fracture that resulted from a twisting injury. Note the medial displacement and shortening of the distal fragment.
Here one can see a spiral shaft fracture after open reduction internal fixation. The large surface area along the fracture site lends itself to healing. The authors used two 2.7 mm lag screws and standard AO technique with cerclage wire to reinforce the f
Here one can see an acute Jones fracture following intramedullary screw fixation with a 4.0 mm partially threaded cancellous screw. This treatment maintains periosteal blood supply and allows for rigid fixation and earlier weightbearing.
(Illustration courtesy of Maria McBride)
82
Author(s): 
By Nicholas Romansky, DPM, and Todd Becker, DPM

Additional References
13. Brown SR, Bennett CH. Management of proximal fifth metatarsal fractures in the athlete. Sports Med. April 2005; 16(2):95-99.
14. Johnson JT, Labib SA, Fowler R. Intramedullary screw fixation of the fifth metatarsal: an anatomic study and improved technique. Foot Ankle International. April 200; 25(4):274-277.
15. Porter DA, Duncan M, Meyer S. Fifth metatarsal Jones fracture fixation with a 4.5 mm cannulated stainless steel screw in the competitive and recreational athlete. Am J Sports Med. 2005; 33(5):726-733.
16. Vogler HW, Westlin N, Mlodzienski AJ, Moller FB. Fifth metatarsal fractures: biomechanicics, classification and treatment. Clin Podiatric Med Surg. October 1995; 12(4):725-747.




References:

CE Exam #140

Choose the single best response to each question listed below.

1. What procedure is generally indicated for a non-reducible fracture and residual displacement of 3 to 4 mm or a sagittal plane with an angulation of 10 degrees?
a) External fixation
b) Arthroplasty
c) Open reduction with internal fixation (ORIF)
d) None of the above

2. When treating most flexural transverse fractures and buckling impaction fractures of the fifth metatarsal, how long should one utilize cast immobilization?
a) Two to three weeks
b) Four to six weeks
c) Four to eight weeks
d) Six to eight weeks

3. Spiral fractures …
a) are the most common neck fracture of the fifth metatarsal
b) may require metatarsal head resection with conversion into an arthroplasty if one cannot reconstruct the articular surface
c) tend to be displaced plantarly along the shearing axis of the fracture
d) all of the above

4. Capital fractures due to compression …
a) tend to involve significant displacement
b) are frequently caused by the demi pointe position related to dancing
c) tend to be quite stable and only involve minor displacement
d) a and b

5. Which type of Jones fracture is common in runners or soccer players?
a) Cervical fractures
b) Capital fractures
c) Proximal diaphyseal stress fractures
d) Metaphyseal-diaphyseal fractures

6. Husain and DeFronzo found less resistance to load failure with …
a) bicortical screw fixation
b) ORIF
c) percutaneous pinning
d) intramedullary screw fixation

7. In a tuberosity fracture, joint displacement of more than __ is one indication for ORIF with intramedullary screws, tension band wiring or fragment excision with tendon repair.
a) 2.5 mm
b) 3 mm
c) 4 mm
d) 5 mm

8. Proximal fifth metatarsal fractures typically demonstrate …
a) severe displacement
b) minimal displacement and heal well with four weeks of orthotic use
c) minimal displacement and heal well with two weeks of a short leg cast and a progressive return to shoe gear
d) severe displacement that can only be corrected with ORIF

9. According to Stewart’s classification, a Type III tuberosity fracture is …
a) an extraarticular fracture of the styloid process
b) an intraarticular fracture of the base of the metatarsal
c) an intraarticular comminuted fracture of the metatarsal base
d) an extraarticular fracture of the base of the metatarsal

10. Which of the following provides 30 percent of the blood supply to the bone of the fifth metatarsal?
a) The network of arteries to the fifth metatarsal
b) The plantar branch of the nutrient artery
c) The joint interface
d) The periosteum

Instructions for Submitting Exams

Fill out the enclosed card that appears on the following page or fax the form to NACCME at (610) 560-0502. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the exam. Responses will be accepted up to 12 months from the publication date.

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