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Metatarsal shaft fractures

INTRODUCTION

The approach to metatarsal fractures varies according to the location and type of fracture. Fractures of the metatarsal shaft are discussed below. Proximal fractures of the fifth metatarsal, metatarsal stress fractures, and toe fractures are discussed separately. (See "Proximal fifth metatarsal fractures" and "Stress fractures of the metatarsal shaft" and "Toe fractures in adults" and "Metatarsal and toe fractures in children".)

EPIDEMIOLOGY AND RISK FACTORS

Excluding toe fractures, metatarsal fractures are the most common foot fracture [1-4]. Approximately one-third of metatarsal fractures involve the shaft or distal portion of the metatarsal. Direct blows and twisting injuries cause many of these fractures. In adults, high forces are required to fracture the first metatarsal. Hence, fractures of the first metatarsal shaft are much less common than fractures of the other metatarsal shafts.

Some populations are at higher risk for traumatic metatarsal fractures:

  • Elderly women with osteoporosis, decreased physical activity, or benzodiazepine use [4]
  • Diabetics, especially if they have had diabetes for greater than 25 years or are more active [3]

RELEVANT ANATOMY

For reference purposes, the metatarsals are numbered from first (largest) to fifth (smallest). The first metatarsal is larger than the others and more important for weight-bearing and balance [5]. Therefore, malalignment of a first metatarsal shaft fracture is not tolerated as well as malalignment of other metatarsal fractures [6] (figure 1A-C).

                

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Literature review current through: Sep 2014. | This topic last updated: Oct 18, 2013.
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References
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  1. Hatch RL, Rosenbaum CI. Fracture care by family physicians. A review of 295 cases. J Fam Pract 1994; 38:238.
  2. Eiff MP, Saultz JW. Fracture care by family physicians. J Am Board Fam Pract 1993; 6:179.
  3. Wolf SK. Diabetes mellitus and predisposition to athletic pedal fracture. J Foot Ankle Surg 1998; 37:16.
  4. Hasselman CT, Vogt MT, Stone KL, et al. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am 2003; 85-A:820.
  5. Armagan OE, Shereff MJ. Injuries to the toes and metatarsals. Orthop Clin North Am 2001; 32:1.
  6. Saraiya MJ. First metatarsal fractures. Clin Podiatr Med Surg 1995; 12:749.
  7. Essentials of Musculoskeletal Care, 2nd, Green WB. (Ed), American Orthopedic Surgeons, Rosemont 2001. p.453.
  8. Eiff MP, Hatch RL. Fracture Management for Primary Care, 3rd ed, WB Saunders, Philadelphia 2011.
  9. Fulkerson E, Razi A, Tejwani N. Review: acute compartment syndrome of the foot. Foot Ankle Int 2003; 24:180.
  10. Perry MD, Manoli A 2nd. Foot compartment syndrome. Orthop Clin North Am 2001; 32:103.
  11. Connolly JF. Fractures and Dislocations: Closed Management, WB Saunders, Philadelphia 1995. Vol 2, p.1026.
  12. Shereff MJ. Complex fractures of the metatarsals. Orthopedics 1990; 13:875.
  13. DiGiovanni CW, Benirschke sk, Hansen ST Jr. Metarsal fractures. In: Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries, Brown BD, Jupiter JB, Levine AM, Trafton PG. (Eds), WB Saunders, Philadelphia 2002. p.2458.
  14. Early JS. Metatarsal fractures. In: Rockwood and Green's Fractures in Adults, Bucholz RW, Heckman JD, Rockwood CA, Green DP (Eds), Lippincott Williams & Wilkins, Philadelphia 2001. p.2215.
  15. O'Malley MJ, Hamilton WG, Munyak J. Fractures of the distal shaft of the fifth metatarsal. "Dancer's fracture". Am J Sports Med 1996; 24:240.