metatarsal stress fracture


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metatarsal stress fracture

a break or rupture of a metatarsal bone caused by prolonged running or walking. The condition is often difficult to diagnose with x-ray films. Also called march fracture.

fracture

breakage of bone or cartilage; all fractures are treated by the same principles of rest and immobilization (e.g. internal fixation and/or casting) and pain control (e.g. non-steroidal anti-inflammatory drugs) Table 1
  • avulsion fracture due to joint capsule, ligament or muscle pulling away from bone, e.g. as in sprain, dislocation or excess muscle contraction; pathological traction of involved soft tissues causes separation of a small area (flake or fleck) of cortical bone

  • closed fracture bone ends do not penetrate through overlying soft tissues or skin

  • Colles fracture fracture and dorsal displacement of distal radius

  • comminuted fracture bone is broken into more than two pieces

  • compound fracture open fracture

  • fatigue fracture march fracture

  • flake fracture avulsion fracture

  • fleck fracture avulsion fracture

  • greenstick fracture bending rather than bone breakage, with minimal fracture on outer curve of the bone; typical of a young bone

  • hairline fracture a very fine fracture line, without fragment separation

  • longitudinal fracture line of fracture is parallel to long axis of bone

  • march fracture; stress fracture fracture due to repeated low-grade trauma, classically affecting shaft of second, third or fourth metatarsal; usually begins as a hairline fracture from medial aspect of bone shaft, at a point one-third from head and two-thirds from base of affected metatarsal; tendency to stress fracture is exacerbated by existing bone pathology (e.g. Paget's disease) and/or osteopenia/osteoporosis (i.e. osteopenia of disuse, menopausal osteoporosis, Charcot neuropathy), unaccustomed or strenuous exercise, or subsequent to revascularization of an ischaemic limb (see stress; stress fracture hypothesis; stress fracture symptoms)

  • neuropathic fracture feature of foot with profound sensory neuropathy and loss of pain response; autonomic dysfunction causes opening of arteriovenous anastomoses (shunts) leading to osteopenia, and imbalance of osteoblast/osteoclast function; presents as a hairline, march/stress fracture; contributes to Charcot joint formation

  • open fracture bone ends perforate through overlying tissues and skin, creating an open wound, and almost certain subsequent osteomyelitis

  • osteoporotic fracture fracture of osteoporotic or osteopenic bone

  • simple fracture closed fracture without bone displacement

  • spiral fracture fracture line follows a spiral track across bone shaft; caused by longitudinal twist to bone

  • stress fracture see march fracture

  • transverse fracture fracture line is at right angles to longitudinal bone axis

Table 1: Categorization of bone fractures
Fracture typeDescription
SimpleThe affected bone is broken into two (or occasionally more) segments by transverse breaks, e.g. metatarsal fracture
SpiralThe fracture line follows a spiral across the bone shaft, e.g. of the distal fibula, in association with a severe inversion injury of the ankle
ComminutedThe affected bone is broken into several/many irregular segments, e.g. the calcaneum after a fall from a height
ImpactedThe bone at the fracture site is compressed together by the jamming force of the impact, e.g. the neck of the fibula after a fall from a height
Open/compoundThe bone at the fracture site is so displaced as to penetrate through the overlying soft tissue and skin, so that the end of the bone is exposed
ComplicatedDeep soft tissues/nerves/blood vessels are traumatized by the sharp end of the fractured bone
AvulsionThe traumatic force causes local soft-tissue structures (muscle origins, tendon insertions, ligaments, joint capsule) to pull off a section of the cortex to which they are attached, e.g. avulsion fracture of the tuberosity of the fifth metatarsal
Stress/overuseThe repeated application of low-level trauma causes eventual fracture of cortical bone, e.g. march fracture of the metatarsal (stress fractures may also affect the sesamoids, styloid process of the fifth metatarsal, calcaneum or tibia)
PathologicalThe bone fractures due to an underlying pathology, e.g. Ewing's sarcoma, Paget's disease or von Recklinghausen's disease affecting the tibia
GreenstickIncomplete fracture through the affected bone; commonly affecting children