(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect Mr. Zhang’s privacy)
Abstract: Metatarsal fracture is a relatively common type of foot fracture, as in the case of Mr. Zhang, the subject of this case, who was walking on a potholed road when he accidentally sprained his foot in an inversion position, resulting in a metatarsal fracture. He showed local swelling and pain and was afraid to walk with weight. The fifth metatarsal fracture was confirmed by orthogonal radiograph, and the alignment of the fracture end was still well maintained, so external fixation in plaster was adopted.
Basic information】Male, 45 years old
Type of disease】Metatarsal fracture
Hospital】Harbin First Hospital
Date of consultation】February 2022
Treatment plan】Conservative treatment (plaster fixation)
Treatment Period】7 days of inpatient treatment, 1 month of outpatient follow-up
Effectiveness】 Pain relief, activity recovery
I. Initial consultation
Mr. Zhang was walking on a potholed road when he accidentally sprained his foot in an inversion position, and the peroneal tendon pulled the base of the fifth metatarsal with great force, causing an avulsion fracture. An X-ray (orthogonal oblique) was taken to confirm the fifth metatarsal fracture (base), and the alignment of the fracture was well maintained, meeting the criteria for conservative treatment. Plaster fixation was recommended to ensure smooth healing of the fracture; surgical treatment would not help the fracture heal, but would instead disrupt the local blood supply and slow down the healing of the fracture. After fully understanding the characteristics of the fifth metatarsal fracture, Mr. Zhang opted for conservative treatment such as plaster fixation and no weight bearing on the affected limb during the fixation of the fifth metatarsal base fracture.
(Orthopantomogram)
(Oblique radiograph)
II. Treatment history
After the metatarsal fracture occurred in Mr. Zhang, the local pain symptoms were significant, but since the fracture end was relatively stable, it was more favorable to take conservative treatment. After Mr. Zhang agreed to the conservative treatment, he was given local plaster fixation. After about 7 days of treatment, the swelling of the affected limb subsided and the cast appeared to be loosened. After confirming that the fracture end was not displaced, the cast was re-fixed and Mr. Zhang was discharged. Mr. Zhang was instructed to elevate the affected limb every day to eliminate swelling at the fracture site quickly by gravity and promote venous return, and to move the joints of the lower limb frequently even in bed to avoid stiffness and muscle atrophy.
III. Treatment effect
After being discharged from the hospital, Mr. Zhang’s metatarsal fracture had completely disappeared after treatment, and he could move freely in bed and resume partial living ability with the aid of double crutches. 1 month of outpatient follow-up, the swelling of the affected limb was obviously eliminated, and the muscle strength and mobility of the lower limb were not abnormal, and he could move on his own, and in order to keep the broken end healing well, it was not recommended to walk with weight on the ground. After about 2.5 months of treatment, Mr. Zhang came to the outpatient clinic for a review, and the X-ray confirmed that the fracture was completely healed, and he could walk with weight on crutches, with no local pain symptoms and no deformity, and could resume normal walking and even jogging activities. As Mr. Zhang insisted on daily functional exercise, the function and flexibility of the ankle joint were not adversely affected.
IV. Notes
We are glad that Mr. Zhang’s pain is relieved and his activities are restored after treatment. After being discharged from the hospital, he should continue to keep the affected limb free from weight-bearing until the positive oblique X-ray of the foot confirms the complete healing of the metatarsal fracture before resuming weight-bearing walking. As the blood supply to the metatarsal fracture site is relatively low, its healing rate is relatively slow. Therefore, extra attention should be paid to protecting the metatarsal fracture end in daily life to avoid delayed healing or even non-healing of the fracture. If Mr. Zhang’s local swelling and pain symptoms do not subside, or worsen again after subside, he should pay great attention and go to an orthopedic clinic to take X-rays to confirm whether there is a metatarsal fracture healing problem, and promptly take care of it, such as refixing.
V. Personal insight
Metatarsal fractures occur mainly due to peroneal tendon pulling, and frequent ankle sprains can weaken the local bone strength of the metatarsal bone, thus constituting the pathological basis of metatarsal fractures. As in the case of Mr. Zhang, the sprain was initially an inversion of the foot, and the excessive pulling of the peroneal tendon led to the fracture of the fifth metatarsal. After treatment, people who have metatarsal fractures should pay extra attention to protecting the ankle area to avoid reoccurrence of ankle sprains. When participating in strenuous sports, such as soccer and basketball, ankle protection can be used, and when walking on potholes, it is recommended to wear high-top shoes to avoid foot entropion sprains. After active prevention, metatarsal fractures are generally less prone to reoccurrence of injury after healing.