Your next patient is a 27 yo woman who inverted her foot while playing netball and is now unable to weight bear due to pain.
This is her Xray:
You know there are 2 types of fractures of the base of the 5th metatarsal, one good and one bad. Which is which?
The more common is a fracture of the tuberosity of the base of the 5th metatarsal. It usually occurs secondary to sudden inversion of a plantar-flexed foot and can masquerade as an ankle sprain (and that is why if somebody presents with a painful ankle you should palpate the base of the 5th metatarsal as well).
It is extraarticular and has good prognosis.This fracture is managed with walking cast / compression wrap or cam boot walker for 2-3 weeks.
The less common but also more serious is a transverse fracture of the base of the 5th metatarsal (Jones fracture) – this is what our patient has. It involves the 4th/5th intermetatarsal articulation and occurs in sports that involve jumping or running.
Treatment of non-displaced fractures is non-weight-bearing cast applied in ED and close Orthopaedics follow-up. They usually have a repeat Xray at 6 – 8 weeks, but they often end up non-weight bearing for a few months.
Displaced fractures should be reduced in ED before casting. They often require internal fixation, same as fractures that occur in elite sports players.