forefoot fractures
DESCRIPTION
Forefoot Fractures. Marie Bamer. What is a Forefoot Fx ?. Those fractures involving the great toe or any of the lesser toes, metatarsals, or sesamoid bones. 3 Types of Forefoot Fractures. Phalangeal Metatarsal Sesamoid. Types of Forefoot Fractures. - PowerPoint PPT PresentationTRANSCRIPT
Marie Bamer
Those fractures involving the great toe or any of the lesser toes, metatarsals, or sesamoid bones.
Phalangeal Metatarsal Sesamoid
Phalangeal Fractures: can involve the neck, shaft, or base of the bone
MOI:Results from a direct trauma or avulsion mechanism
*fx of 1st from being hit with an axe
Metatarsal Fractures: Fx of a metatarsal
MOI: fractures of the 1st- 4th usually result in direct trauma. 2nd -5th may occur as result of a twisting injury
* Jones Fx- proximal 5th metatarsal shaft
Sesamoid Fractures: splitting or fragmentation of one or both of the two small bones contained within the tendon of the flexor hallicus longus
MOI: often secondary to the impact of the foot on a hard surface while toes are dorsiflexed.
*A) Comminuted fx B) Post-op resection of bone
Orthopaedic Objectives Anatomical alignment of the great toe, phalanx,
metatarsal and sesamoid is essential in weight bearing and load distribution on the foot.
Alignment of the 2nd- 5th metatarsals is important to minimize problematic gait and painful fitting of shoes
Forefoot stability is important to maintain stable and pain-free gait
Rehabilitation Objectives
Range of Motion-restore and maintain all ROM
Muscle Strength- improve and restore strength of extensors, flexors, invertors, and evertors in foot
Functional Goals- normalize gait to pre-injury pattern
Lesser Phalanx Fx: 4 to 6 weeks 2nd, 3rd and 4th Metatarsal Fx: 4 to 6 weeks
5th Metatarsal Fx ( Jones Fx): 6 to 8 weeks
Great Toe Phalanx Fx: 4 to 6 weeks
1st Metatarsal Fx: 6 to 8 weeks
Sesamoid Fx: 4 to 8 weeks
Lesser Phalanx Fx: 2 to 6 weeks 2nd, 3rd and 4th Metatarsal Fx: 4 to 6 weeks
5th Metatarsal Fx (Jones): 4 to 6 weeks (acute), 6 to 10 for delayed union, nonunion, or stress fx
Great Toe Phalanx Fx: 4 to 6 weeks
1st Metatarsal Fx: 4 to 6 weeks
Sesamoid Fx: 8 to 12 weeks, possibly longer after sesamoidectomy
Lesser Phalanx Fx
Splints or Buddy Taping
Open Reduction and Percutaneous PinningK –wires and short leg cast for 2-3 weeks
*distal phalanx of 5th
2nd, 3rd, 4th Metatarsal Fx
Cast-short leg walking *if undisplaced or minimally
displaced Closed Reduction and
Percutaneous Pinning*closed, displaced or angulated fx-
NWB cast for 2-3 weeks
Open Reduction and Internal Fixation
*open, displaced- NWB cast for 2-3 weeks
* 2nd MT
5th Metatarsal Fx (Jones)
Cast/Splint• Acute avulsion=walking boot if
displacement is less than 2 mm• Jones of proximal end= NWB cast Open Reduction and Internal
Fixation• Avulsion of greater than 2 mm=
tension-band wire or lag screw • Delayed or non-union require
intramedullary screw• NWB cast approx 6 weeks
Great Toe Phalanx Fx
Cast- NWB extended to toes Closed Reduction and Percutaneous Pinning or Open Reduction
and Internal Fixation
1st Metatarsal Fx
Cast Open Reduction and Internal Fixation
Sesamoid Fx
Cast/ Splint Sesamoidectomy
Day of injury to 1 week
Stability of fx site: None Stage of Bone Healing: Inflammatory
phase Radiograph: No callus
* NWB, check cap refill, no deformities, radiograph,
Two Weeks
Stability of fx site: None to minimal Stage of bone healing: Begins reparative
phase Radiograph: No change or early callus
Four to Six Weeks
Stability of fx site: Bridging callus and fx usually stable (acute fx)
Stage of bone healing: reparative phase Radiograph: Bridging callus visible
Six to Eight Weeks
Stability of fx site: Fx stable with bridging callus
Stage of bone healing: reparative phase Radiograph: Bridging callus visible w/
increased ridgidity. Fx line less distinct
Eight to Twelve Weeks
Stability of fx site: Stable Stage of bone healing: Remodeling Phase Radiograph: abundant callus
Age – elderly at higher risks for joint stiffness
Articular Involvement- any fx in forefoot requires anatomic reduction
Location Open Fractures- all must be treated
aggressively with irrigation, debridement, and intravenous antibiotics