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Fractures of the base of the fifth metatarsal in children and adolescents

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									           Fractures of the base of the fifth
                metatarsal in children
                   and adolescents

                           José A. Herrera-Soto, MD
                             Michael Scherb, MD
                              Michael Duffy, MD
                              Jay C. Albright, MD
            This study was conducted at the Nemours Children’s Clinic-Orlando

2007 EPOS annual meeting
                           INTRODUCTION
   • Fractures of the fifth metatarsal are the most
     common metatarsal fractures in children (45%)

   • There are no reports in the literature on the
     management of these injuries in children

   • Their treatment is based on adult literature



2007 EPOS annual meeting
                           PURPOSE
   • Identify the most common types of fifth
     metatarsal fractures

   • Determine the mean time to fracture healing
     of these different types of metatarsal
     fractures

   • Examine whether current adult
     recommendations can be extrapolated to
     children

2007 EPOS annual meeting
         MATERIALS AND METHODS
   • 90 fractures were identified in 88 patients
         – 30 apophyseal
         – 45 intraarticular
         – 15 “Jones fractures”


   • 45 males and 43 females

   • Mean age of 12.7 years (range, 5-19 years)


2007 EPOS annual meeting
                           RESULTS
• 30 apophyseal injuries
     – Avg. age = 13 years



• ALL did well with 3-6
  weeks of short-leg walking
  cast
     – Including displaced fragments




2007 EPOS annual meeting
                     RESULTS
• 45 with intraarticular fractures
     –   Avg. age = 12.4 years
     –   Most treated with a walking cast
     –   33 non-displaced
     –   12 displaced

• Healing time non-displaced = 37 days

• Length of Tx for displaced = 58 days

• Difference in healing time was
  statistically significant (p=0.009)

2007 EPOS annual meeting
                     RESULTS
• Initial treatment for “Jones fracture” was:
     – Walking cast for four weeks:           8
     – Non-weight bearing cast for six weeks: 5
     – Immediate intramedullary fixation:     2

• The average length of treatment from the
  day of injury to the day of fracture
  healing was 12.1 weeks

• Average length for primarily fixed was
  6.7 wks


2007 EPOS annual meeting
                     RESULTS
• “Jones fractures”
      – Avg. Age = 14 years

• Three patients of the NWB group
  presented with refracture within
  3-10 weeks of cast removal.

• All refractures underwent
  intramedullary fixation with a
  cannulated lagged screw
      – All healed uneventfully
      – All were teenagers and athletic
2007 EPOS annual meeting
                           Discussion
   • Most fractures of the 5th metatarsal apophysis
     do well clinically after a course of walking cast

   • Non-displaced intraarticular fractures do well
     with weight-bearing cast

   • Displaced intraarticular fractures respond better
     to non-weight bearing cast


2007 EPOS annual meeting
                           DISCUSSION
   • “Jones” fractures may warrant intramedullary
     fixation to get patients back quickly to regular
     activities, avoid delays in healing and prevent
     refracture

   • Most of the pediatric injuries to the 5th
     metatarsal fractures behave similarly to those
     found in adults


2007 EPOS annual meeting

								
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