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Most broken toes can be treated without surgery. Radiographic evaluation is dependent on the toe affected; a complete foot series is not always necessary unless the patient has diffuse pain and tenderness. There is typically focal tenderness, swelling, and ecchymosis at the base of the fifth metatarsal. All Rights Reserved. In this type of injury, the tendon that attaches to the base of the fifth metatarsal may stretch and pull a fragment of bone away from the base. Illustrations of proximal interphalangeal joint (PIPJ) fracture-dislocation patterns. Which of the following is responsible for the apex palmar fracture deformity noted on the preoperative radiographs? All critical aspects of phalangeal fracture care will be discussed with pertinent case examples. Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for four to six weeks. Each metatarsal has the following four parts: Fractures can occur in any part of the metatarsal, but most often occur in the neck or shaft of the bone. The use of musculoskeletal ultrasonography may be considered to diagnose subtle metatarsal fractures. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. While celebrating the historic victory, he noticed his finger was deformed and painful. An X-ray can usually be done in your doctor's office. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. Because it is the longest of the toe bones, it is the most likely to fracture. Stress fractures have a more insidious onset and may not be visible on radiographs for the first two to four weeks after the injury. Examination should consist of a neurovascular evaluation and palpation of the foot and ankle. A fractured toe may become swollen, tender, and discolored. An attempt at reduction and immobilization is made in the field by his unit physician assistant, and he returns to your office one week later. A 19-year-old cross country runner complains of 3 months of foot pain with running. Approximately 10% of all fractures occur in the 26 bones of the foot. If you have an open fracture, however, your doctor will perform surgery more urgently. Therefore, phalanges and digits adjacent to the fracture must be examined carefully; joint surfaces also must be examined for intra-articular fractures (Figure 3). Pediatric Phalanx Fractures: Evaluation and Management Proximal Phalanx Fracture : Wheeless' Textbook of Orthopaedics Patients with a proximal fifth metatarsal fracture often present after an acute inversion of the foot or ankle. Copyright 2023 American Academy of Family Physicians. A 20-year-old male military recruit slams his index finger on a tank hatch and sustains the injury seen in Figure A. Follow-up visits should be scheduled every two weeks, and healing time varies from four to eight weeks.3,6 Follow-up radiography is typically required only at six to eight weeks to document healing, or earlier if the patient has persistent localized pain or continued painful ambulation at four weeks.2,3,6. Toe fractures, especially intra-articular fractures, can result in degenerative joint disease, and osteomyelitis is a potential complication of open fractures. A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Thank you. Three muscles, viz. In most cases, a fracture will heal with rest and a change in activities. This usually occurs from an injury where the foot and ankle are twisted downward and inward. Lgters TT, We help you diagnose your Toe fractures case and provide detailed descriptions of how to manage this and hundreds of other pathologies . (Left) In this X-ray, a recent stress fracture in the third metatarsal is barely visible (arrow). Fractures of the proximal phalanx of the hallux involving the epiphysis may be intra-articular. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. To minimize the possibility of future disability, the position of the bone fragments after reduction should be as close to anatomic as possible. They are common in runners and athletes who participate in high-impact sports such as soccer, football, and basketball. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. PDF Fractures of the Proximal Phalanx and Metacarpals in the Hand The reduced fracture is splinted with buddy taping. A 26-year-old professional ballet dancer presents with insidious onset of right midfoot pain which began 6 months ago. Proximal phalanx fractures often present with apex volar angulation. In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment. The Ottawa Ankle and Foot Rules should be applied when examining patients with suspected fractures of the proximal fifth metatarsal to help decide whether radiography is needed14 (Figure 815 ). 2 ). Proper . If stable, the patient can be transitioned to a short leg walking cast or boot3,6 (Figures 411 and 5). While many Phalangeal fractures can be treated non-operatively, some do require surgery. Type in at least one full word to see suggestions list, 2022 California Orthopaedic Association Annual Meeting, COA Foot and Ankle End - Glenn Pfeffer, MD, Comminuted Fifth Metatarsal Fracture in 28M. Adjuvant imaging techniques to analyze fracture geometry and plan implant placement, will be discussed in detail. Unless it is fairly subtle, rotational deformity should be corrected by further manipulation. Ulnar side of hand. Posterior splint; nonweight bearing; follow-up in three to five days, Short leg walking cast with toe plate or boot for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to six weeks, Open fractures; fracture-dislocations; intra-articular fractures; fractures with displacement or angulation, Short leg walking boot or cast for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to eight weeks, Open fractures; fracture-dislocations; multiple metatarsal fractures; displacement > 3 to 4 mm in the dorsoplantar plane; angulation > 10 in the dorsoplantar plane, Three-view foot series with attention to the oblique view, Compressive dressing; ambulate as tolerated; follow-up in four to seven days, Short leg walking boot for two weeks, with progressive mobility and range of motion as tolerated; follow-up every two to four weeks; healing time of four to eight weeks, Repeat radiography at six to eight weeks to document healing, Displacement > 3 mm; step-off > 1 to 2 mm on the cuboid articular surface; fracture fragment that includes > 60% of the metatarsal-cuboid joint surface, Short leg nonweight-bearing cast for six to eight weeks; cast removal and gradual weight bearing and activity if radiography shows healing at six to eight weeks, or continue immobilization for four more weeks if no evidence of healing; healing time of six to 12 weeks, Repeat radiography at one week for stability and at the six- to eight-week follow-up; if no healing at six to eight weeks, repeat radiography at the 10- to 12-week follow-up, Displacement > 2 mm; 12 weeks of conservative therapy ineffective with nonunion revealed on radiography; athletes or persons with high activity level, Three-view foot series or dedicated phalanx series, Short leg walking boot; ambulate as tolerated; follow-up in seven days, Short leg walking boot or cast with toe plate for two to three weeks, then may progress to rigid-sole shoe for additional three to four weeks; follow-up every two to four weeks; healing time of four to six weeks, Repeat radiography at one week if fracture is intra-articular or required reduction, Fracture-dislocations; displaced intra-articular fractures; nondisplaced intra-articular fractures involving > 25% of the joint; physis (growth plate) fractures, Buddy taping and rigid-sole shoe; ambulate as tolerated; follow-up in one to two weeks, Buddy taping and rigid-sole shoe for four to six weeks; follow-up every two to four weeks; healing time of four to six weeks, Displaced intra-articular fractures; angulation > 20 in dorsoplantar plane; angulation > 10 in the mediolateral plane; rotational deformity > 20; nondisplaced intra-articular fractures involving > 25% of the joint; physis fractures. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5. It is one of the most common fractures of the foot and has unique characteristics that make it more likely to require surgery. The choice of immobilization device depends on the patient's ability to ambulate with the device with minimal to no pain. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. Deformity of the digit should be noted; most displaced fractures and dislocations present with visible deformity. 21(1): p. 31-4. Patients should limit icing to 20 minutes per hour so that soft tissues will not be injured. Adult foot fractures: A guide | Clinician Reviews - MDedge Patients with closed, stable, nondisplaced fractures can be treated with splinting and a rigid-sole shoe to prevent joint movement. In an analysis of 339 toe fractures, 95% involved less than 2 mm of displacement and all fractures were managed conservatively with good outcomes.25, The most common mechanisms of injury are axial loading (stubbing) or crush injury. This webinar will address key principles in the assessment and management of phalangeal fractures. In many cases, anteroposterior and oblique views are the most easily interpreted (Figure 1, top and bottom). Metatarsal Fractures - Foot & Ankle - Orthobullets Pediatric Phalanx Fractures. - Post - Orthobullets And finally, the webinar will cover fixation techniques, including various instrumentation options.Moderator:Jeffrey Lawton, MDChief, Hand and Upper ExtremityProfessor, Orthopaedic SurgeryAssociate Chair for Quality and Safety, Orthopaedic SurgeryProfessor, Plastic SurgeryUniversity of MichiganAnn Arbor, MichiganFaculty: Charles Cassidy, MDHenry H. Banks Professor and ChairmanDepartment of OrthopaedicsTufts Medical CenterBoston, MassachusettsChaitanya Mudgal, MD, MS (Ortho), MChHand Surgery ServiceDepartment of OrthopedicsMassachusetts General HospitalChairman, AO NA Hand Education CommitteeAssociate Professor, Orthopedic Surgery, Harvard Medical SchoolBoston, MassachusettsAmit Gupta, MD, FRCSProfessorDepartment of Orthopaedic SurgeryUniversity of LouisvilleLouisville, KentuckyRebecca Neiduski, PhD, OTR/L, CHTDean of the School of Health SciencesProfessor of Health SciencesElon UniversityElon, North Carolina, Ring Finger Proximal Phalanx Fracture in 16M. Rotator Cuff and Shoulder Conditioning Program. In some cases, a Jones fracture may not heal at all, a condition called nonunion. What is the optimal treatment for the proximal phalanx fracture shown in Figure A? Minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts (Figure 2) and fractures with less than 10 of dorsoplantar angulation in the absence of other injuries can generally be managed in the same manner as nondisplaced fractures.24,6 Initial management includes immobilization in a posterior splint (Figure 311 ), use of crutches, and avoidance of weight-bearing activities. Follow-up should occur within three to five days to allow for reduction of soft tissue swelling. Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. Proximal Phalanx Fracture Management. - Post - Orthobullets Treatment is generally straightforward, with excellent outcomes. Methods: We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. Which of the following acute fracture patterns would best be treated with open reduction and internal fixation? Fracture of the proximal phalanx of the little finger in children: a classification and a method to measure the deformity . Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe.