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