Metatarsal fracture

Definition / introduction

Of the Metatarsal fracture (Metatarsal fracture) is a fracture of the metatarsal bones. Such a break is often triggered by falling objects, traffic accidents or Sports injuries. About 1/3 of all foot fractures are metatarsal fractures. The healing process is typically straightforward and the incidence of infections or persistent chronic complaints is low.

root cause

Often acute trauma or stress fractures are the cause of one Metatarsal fracture. Stress fractures are usually the answer to chronic stress. Accordingly, athletes (Dancers, runners, footballers) affected by this type of fracture. Since the metatarsal bones are fixed by strong ligaments, such a break is rare in mild trauma.

Signs

A Metatarsal fracture arises from a force acting on the bony structures.This can either act on the foot from the outside or be caused by twisting the foot. If after such a situation, strong stress-dependent Pain arise on the foot, which are accompanied by swelling that occurs quickly, this is the first sign of a Metatarsal fracture to understand. The later onset of bruising on the foot reinforces the suspicion of a metatarsal fracture. In order to be able to say with certainty that there is a metatarsal fracture, however, an X-ray must be taken.

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Often the band structures and Muscles affected. Exceptions to this are the subcapital Metatarsal boneswhich are not so stable and can therefore be easily moved backwards. Multiple metatarsals are often involved in severe trauma. The soft tissue involvement in particular plays a very important role in these cases. In addition, massive trauma can lead to instability of the entire foot column.
In such cases one should primarily Compartment syndrome be excluded at the foot. This is a significantly increased tissue pressure in a closed section. This increased pressure leads to tissue damage and compression of the vascular and nerve supply and thus represents an emergency.

Pain

Pain are in the foreground of the symptoms when a metatarsal fracture occurs. In addition to pain, swelling and a bruise on the foot are particularly typical of the injury. It can happen that immediately after the break through the Stress responsewhich is caused by the break for a short time no pain is perceived. As a rule, however, this inevitably occurs after some time. Typically, the pain occurs particularly in one burden of the affected foot and is released with the slightest pressure on the foot. The pain can be treated with certain pain medication. These can be given orally or administered into the vein. Careful pain management is an important part of metatarsal fracture therapy.

Pain is also common after therapy. This is not necessarily related to the success of the treatment. Stress-dependent pain can be particularly severe after a Plaster removal occur. Complete freedom from pain, even when the metatarsus is fully loaded, is sometimes only achieved after several months. However, if the pain is severe and may be accompanied by other symptoms, a possible complication of the treatment should be excluded.

swelling

In addition to severe, stress-dependent pain and a bruise, that is swelling the soft tissues of the foot typical of a metatarsal fracture. In medicine, such a swelling is also referred to as a traumatic edema. It arises because the force also damages soft tissues in addition to the bones. Through the reinforced Blood circulation and the leakage of fluid from the vessels creates the swelling. The swelling of the metatarsus can be treated by a Elevate and Cool of the foot. In general, however, the fracture should be clarified by a doctor and receive comprehensive professional treatment so that the disease progresses optimally.

Diagnosis

Often all that is needed to make a diagnosis is the anamnesis, description of the course of the accident and a conventional X-ray from the front (anterior-posterior), as well as at an angle. If an extensive, massive comminuted fracture of the metatarsal bones is suspected, a computed tomogram (CT) can provide more precise information about the extent of the accident. Pure ligament or muscle injuries should be ruled out during these recordings, as specific therapy is only possible with a precise diagnosis.

Classification

Since the therapy is strongly dependent on the extent of the injury, a classification is first undertaken, which leads to appropriate therapeutic approaches. First of all, it is particularly important whether there is soft tissue involvement, whether the fracture is stable or unstable and where the fracture is located exactly. In terms of soft tissue involvement, a distinction is made between closed and open fractures. In addition, the compartment syndrome should be differentiated from this, as it involves the nerves. The stability of the fracture depends on the number of midfoot bones involved. Singular fractures, serial fractures and dislocation fractures are differentiated. The fracture itself can be at the base, shaft, subcapital, and head.

Healing / duration

The individual course of the disease and thus the time it takes for a metatarsal fracture to heal is influenced by various factors. The type of fracture, the age of the person affected, the presence of other damaged structures of the foot and the individually applied therapy method are particularly relevant.

Experience has shown that older patients struggle with a metatarsal fracture for much longer. If, in addition to the broken metatarsal bone, there is also damage to joints or wounds, or if there are multiple fractures, this typically has an unfavorable effect on the healing process. Fractures that can only be treated by surgery usually take longer to heal. For example, fractures that are caused by an enormous blunt force and that cause a so-called comminuted fracture with a large number of bone fragments only heal slowly after the operation. The blood supply to the bone is essential for the healing process after a fracture. The individual course of the blood vessels and the location of the rupture also determine the duration and therapy of the disease.

Bones are structures that heal relatively slowly. In many cases, however, the foot can be loaded before the bone has completely healed. Often, after about 6 weeks, the foot can be put under pressure again to some degree without pain. In many cases, a plaster cast is placed within these six weeks to completely immobilize the metatarsus and thus allow the bone fragments to heal properly. A load-bearing capacity that comes close to that before the break, however, is usually only achieved much later. The foot can often only be fully loaded again after six months. In individual cases, the complete healing phase can take up to a year.

Please also read the article: Duration of a metatarsal fracture

Complications that can arise during treatment and during the course of a metatarsal fracture also influence the healing time. In the case of infections and pain that persist even after a few months, further therapy may be necessary, which further extends the healing of the bone until the symptoms are completely free.

surgery

It is crucial for the correct healing of a metatarsal fracture to restore the bone fragments to their original state. The broken edges of the bone should be brought together exactly so that the bone can take on the same function after healing and is as stable as before. In many cases this can be called Repositioning the bones This is done using wires from the outside and no open surgery is performed. If this is not possible, however, an operation is absolutely necessary in order to achieve an optimal treatment result.

To gain access to the bone fragments, a skin incision is made over the broken bone. Now the careful exposure and repositioning of the bone pieces begins. To a Fixation The fragments are usually connected to one another to ensure that the pieces remain intact after the operation. This can be achieved, for example, by screwing plates together. To ensure that the plates and screws are correctly placed, images of the affected area are created during the operation using X-ray technology, which can give the surgeon immediate feedback on his actions. In addition to screws and plates, the use of wires can also ensure sufficient stability. The intricacies of individual therapy are often decided during surgery.

After the bony structures of the metatarsus have completely healed, the plates, screws or wires can be removed. However, this action requires another operation. Depending on the material used, such a removal is more or less complex. The plates need not be removed in every case. The attending surgeon will give individual advice on the advantages and disadvantages of removing the fixation in individual cases.

Whether it makes sense to perform an operation in general or whether it is just creating one Plaster cast sufficient depends on the individual situation. The performance of a comprehensive diagnosis and the use of diagnostic imaging instruments have a decisive influence on the recommendation of the attending physician.

forecast

The The prognosis of a metatarsal fracture is usually good. Due to the specific therapy options for the metatarsal fracture, the various fractures can be optimally treated. In addition, fractures of the metatarsal bones often heal without problems. Risks of infection or post-operative problems are also usually rare.

Summary

Since the Metatarsal fracture about 1/3 of all foot fractures it is a common trauma surgical diagnosis that is not only caused by accidents. Athletes are particularly often affected by the great stress on the metatarsal bones. In order to achieve optimal healing and a good result, the exact diagnosis and appropriately adapted therapy are essential. Because of this, the Fractures are divided into various groupsaccording to which the therapy is organized. Since the therapy options are very good these days, the fractures usually heal well and without complications and enable a subsequent full load.