Because of its specificity, it is usually discussed separately.
I Causes of injury: mainly related to sports and physical activities, partly due to the impact of car accidents
II Classification
1 Proximal basal fracture: A First zone injury: avulsion fracture is usually a single piece and often presents as comminuted if it is a direct impact (see Figure 1) Wang Tao, Department of Orthopedics, Affiliated Hospital of Qinghai University
Figure 1
B Second zone injury: true Jones fracture, tension fracture of the lateral aspect of the metaphyseal junction due to forefoot inversion (see Figure 2)
Figure 2
C Third zone injury: rare. It occurs mainly in athletes, and repetitive cyclic loading is the underlying mechanism by which this injury occurs in high-intensity athletes. The fracture is usually preceded by weeks or months of pain at the lateral margin of the proximal metatarsal bone before the fracture appears radiographically. (See Figure 3.) Figure 3
2 Distal spiral fracture (dancer’s fracture).
III Treatment
1 First zone injuries and choreographer’s fractures: closed repositioning gives excellent results. Hard-soled shoes and tubular casts are equally effective, and casts are usually immobilized for 8-10 weeks; in the rare cases where the fracture involves the fifth metatarsal appendage joint, the joint should be repaired by open surgery to restore alignment. However, if the fracture is severely crushed, with many and very small bone fragments, and cannot be fixed with normal internal fixation, it should be fixed in a closed reduction cast, as surgery in this case is not at all beneficial.
2 Second zone injury (treatment is controversial): A If the patient can tolerate it, it is better to use a weight-bearing short-leg cast for 8-10 weeks.
B If not tolerated, surgery can be performed
3 third zone injury: generally have anterior pain symptoms, part of the x-ray performance of the second zone injury combined with anterior pain symptoms should also be classified as a third zone injury.
A Initially, a non-weight-bearing tubular cast can be used for 3 months, but for symptomatic bone non-union should be treated surgically.
B Surgical implants and fixation are recommended for professional athletes and occupations with high activity demands.
C Surgery is also recommended for imaging findings of severe fracture displacement.
IV Complications
Complications are rare if managed properly.
Bone nonunion can occur in zone I injuries and is usually asymptomatic and does not require special management. If painful symptoms are present, fracture fragments can be removed; or internal fixation with bone graft screws can be performed for larger fractures.
Bone nonunion due to second and third zone injuries depends more on the treatment. Failure of surgical procedures is usually due to premature activity, inappropriate bone grafting, or incomplete debridement of the medullary bone.