Avulsion Fractures of the Ankle
Original Editors - Niels Verbeeck
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Search Strategy[edit | edit source]
Key words: Avulsion fractures, ankle, 5th metatarsal, treatment, diagnosise
An avulsion fracture of the 5th metatarsal is also called Pseudo-Jones fracture.
Main information: VUB (Free University of Brussels) library (books) and sites: Pubmed, Web of knowledge (RCT’s), PEDro evidence
Definition/Description
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An avulsion fracture is a fracture caused by a traumatic traction (longterm repetitive pulling or single high impact traumatic traction) from a tendon to the bone. Because the tendon can bear more pull than the bone, it is common that the bone will pull off instead of the tendon. The tendon pulls off a tiny fragment of bone.[1]
An avulsion fracture can occur at many places in the body, but some areas in the body are more sensitive than others. An avulsion fracture of the ankle is mostly situated at the base of the fifth metatarsal, but may also be found at the talus and calcaneus.
Clinically Relevant Anatomy[edit | edit source]
The 5th metatarsal is located at the lateral side of the foot. The metatarsal is divided into 3 parts: the base (also called tuberosity), the metaphysis and the head. The peroneus (fibularis) brevis’ is attached at the lateral side of the tuberosity metatarsal V.(red area at figure) The peroneus (fibularis) tertius’ is attached at the dorsal side of the most proximal compartment of the metaphysis. Because of large traction by these structures, during inversion injury, tuberosity avulsion fractures occur. (between red and purple area at figure)
figure1: source: http://www.med-info.nl/images/images_trauma/Trauma_voet_MT5_Jones_groot.jpg
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
Avulsion fractures are often confused with other types of fractures to the fifth metatarsal:
- Jones fractures
- Stress fractures
- Mid-shaft fractures
Diagnostic Procedures[edit | edit source]
An x-ray may be ordered by the surgeon. Avulsion fractures are sometimes overlooked when an x-ray is taken or when the injury to MT V occurs together with an ankle sprain. In this case other imaging studies are recommended, such as MR imaging, CT scan or scintigrams.
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
During the medical history taking the surgeon or a physiotherapist has to ask the patient how the injury occurred and when the pain started. Using the Ottawa Ankle Rules localize the exact area of pain. Palpation of the 5th metatarsal tuberosity is painfull.
Medical Management[edit | edit source]
Patients with an avulsion fracture of the base of the 5th metatarsal are usually treated conservative. If the bone is not displaced, the treatment is accomplished with a walking boot or a walking cast. They will be casted for four to six weeks. Surgery is only recommended if the bone is displaced from its normal position or when there is more than 30% of the cubometatarsal joint involved. The bone will be removed or fixed with osteosynthesis material. Crutches may be useful to avoid weight on the injured foot.
Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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