Metatarsal and Phalangeal Fractures | Zones, Imaging & Treatment Explained скачать в хорошем качестве

Metatarsal and Phalangeal Fractures | Zones, Imaging & Treatment Explained

Clinical context & anatomy: Metatarsals (1–5): base, shaft, neck, head; 1st & 5th stabilize the foot columns. 5th metatarsal base: insertion of peroneus brevis & plantar fascia → watershed blood supply → risk of delayed or nonunion. Phalanges: hallux critical for push-off; injuries highly disabling. Fracture patterns: Comminuted (high-energy), displaced neck, oblique vs transverse, avulsion of 5th tuberosity. 5th metatarsal zones: Zone 1: avulsion (pseudo-Jones). Zone 2: true Jones fracture (high nonunion risk). Zone 3: proximal diaphyseal stress fracture. Evaluation & imaging: Pain, swelling, tenderness, ecchymosis, difficulty weight-bearing. X-ray: AP, lateral, oblique. MRI/bone scan for stress fractures. Precise localization in 5th MT needed to assign zone. Treatment: Nondisplaced shaft: stiff-soled shoe, cast, or boot. Displaced/angulated: reduction, percutaneous pinning or ORIF. 5th MT base: zone-dependent management. Phalangeal fractures: buddy taping (lesser toes); surgical fixation for hallux displacement. Complications: Nonunion (proximal 5th MT), malunion, post-traumatic arthritis, loss of push-off strength, gait abnormalities.