Diferencia entre revisiones de «Foot and toe fractures»

Revisión del 00:22 18 feb 2012

Hindfoot

Talus

Background

Almost always associated with other injuries

Diagnosis

CT often required for accurate diagnosis

Management

Major fracture (talar neck and head)
- Immediate ortho consultation required (high rate of avascular necrosis)
Minor fracture
- Posterior splint, NWB, ortho referral

Calcaneus

Background

Associated injuries are common
Types
- Intra-articular (75%)
  - Sclerotic line may be only evidence of impacted fracture
- Extra-articular (25%)
  - Anterior process fx is most common

Diagnosis

Imaging
- Decreased Boehler's angle (<25') may be only sign of fx (compare w/ opposite side)

Treatment

Intra-articular fracture
- Immobilization w/ posterior splint
- Non-weightbearing
- Elevation (very important - fx has high rate of severe swelling)
- Ortho consult
Extra-articular fracture
- Immobilization and close ortho f/u

Images

(A) Normal Boehler's angle and (B) Abnormal Boehler's angle

File:Boehler's Angle.jpg

Midfoot

LisFranc Injury

See Lisfranc Injury

=Navicular/Cuboid/Cuneiform

All are diagnosed/managed in similar way
- Imaging: (weight-bearing AP, lateral, oblique)
  - CT sometimes necessary
- Treatment: Non-weightbearing short leg cast, ortho referral

Forefoot

Fifth Metatarsal

Background

3 types of fractures:
- 1. Tuberosity fracture
  - Occurs due to forced inversion foot/ankle
- 2. Jones or metaphyseal-diaphyseal junction fracture
  - Occurs due to sudden change in direction w/ heel off the ground
- 3. Diaphyseal stress fracture
  - Occurs through repetitive microtrauma

Diagnosis

Plain radiographs are usually adequate

Management

Tuberosity Fracture
- Walking cast and weightbearing as tolerated
Jones Fracture (non-displaced)
- Posterior splinting, NWB, ortho referral
Diaphyseal Stress Fracture
- Ortho referral

Metatarsal

Background

Must rule-out associated Lisfranc injury

Management

Posterior splint, NWB, ortho referral in 2-3d

Phalange

Management: buddy-taping, hard-soled shoe

@@ Línea 40: / Línea 40: @@
 ==Midfoot==
+===LisFranc Injury===
+*See [[Lisfranc Injury]]
-==Fifth Metatarsal==
+===Navicular/Cuboid/Cuneiform==
-===Jones Fracture===
+*All are diagnosed/managed in similar way
-*<1.5 cm from proximal tip of 5th metatarsal
+**Imaging: (weight-bearing AP, lateral, oblique)
-*transverse
+***CT sometimes necessary
-*ORIF
+**Treatment: Non-weightbearing short leg cast, ortho referral
-===Dancer's (Avulsion) Fracture===
+==Forefoot==
-*proximal tip of 5th metatarsal (more proximal than Jones)
+===Fifth Metatarsal===
-*avulsion (spiral) fracture, frequently displaced
+====Background====
-*inversion injury (common in ballet dancers)
+*3 types of fractures:
-*Do not confuse unfused apophysis with a fracture!
+**1. Tuberosity fracture
-*treatment
+***Occurs due to forced inversion foot/ankle
-** mildly displaced: heal w/ 6 to 8 weeks w/ short leg cast
+**2. Jones or metaphyseal-diaphyseal junction fracture
-** displaced frxs (3-5 mm): may require ORIF
+***Occurs due to sudden change in direction w/ heel off the ground
+**3. Diaphyseal stress fracture
+***Occurs through repetitive microtrauma
-==[[Lisfranc Injury]]==
+====Diagnosis====
+*Plain radiographs are usually adequate
+====Management====
+*Tuberosity Fracture
+**Walking cast and weightbearing as tolerated
+*Jones Fracture (non-displaced)
+**Posterior splinting, NWB, ortho referral
+*Diaphyseal Stress Fracture
+**Ortho referral
+===Metatarsal===
+====Background====
+*Must rule-out associated Lisfranc injury
+====Management====
+*Posterior splint, NWB, ortho referral in 2-3d
+===Phalange===
+*Management: buddy-taping, hard-soled shoe
 ==See Also==