5th Metatarsal

Fractures

BLOOD SUPPLY

CLASSIFICATION

• ZONE 1: Tuberosity (AVUSLION) Fractures

• ZONE 2: MD Junction (JONES) Fractures

• ZONE 3: Diaphyseal (STRESS) Fractures

AVULSION

FRACTURES

• Cast

JONES FRACTURE

• INDICATIONS FOR SURGERY:

• Athlete

• Patient Demand (wants to go back to work quickly,

not willing to take risk of Nonunion)

• Nonunion, Refracture

• Cavovarus hind foot

TECHNIQUE

Entry Point

COMPLICATIONS OF

SURGERY

• nonunion

• hardware breakage, prominent hardware

• peroneal tendon irritation

• sural nerve injury

Nonunion of 5th MT

• Debridement

• Bone Grafting

• Compression

• Immobilization

DIABETIC ANKLE

FRACTURES

• How they are different?

ISSUES

• Impaired Vascularity (Co existing PVD)

• Neuromuscular Imbalance

• Absence of Pain, “Protective Sensations”

• Delayed Healing of Bones

• Obesity

DIABETIC FOOT

• Neuropathic Foot: Identify by sensory examination

• Non Neuropathic Foot.

Diabetic but non neuropathic

• Routine fracture care, Better to err on extra fixation

Neuropathic Foot

• Augment Fixation

• 2 Methods

Manoli’s techniqueWashington Uni

Post op

• Double NWB time (3 months for ankle fracture)

• Cautious WT bearing, regular check X-rays.

SYNDESMOSIS

INJURY

DIAGNOSIS

• HISTORY: Mechanism of Injury

• EXAMINATION : squeeze test, stress test

DIAGNOSIS

• Medial

clear space

• T/F Interval

• T/F Overlap

Intraop Assessment

• Cotton’s Test

• Ballotment

TREATMENTScrews Tight Rope(Fiber, Button)

Q1)When to remove syndesmosis screws?

• If restricted Dorsiflexion at 3 months, then remove otherwise don’t. Broken

screws means it has self dynamised.

Q2)Advantage of Tight Rope?

• physiological motion and stability

Q3) Unicortical or bicortical?

• Bicortical

Q4) Position of ankle while tightening of screws?

• Neutral, no hyperdorsiflexion.

LISFRANC INJURIES

• TMT joint is the Lisfranc Joint

• LISFRANC INJURIES is an Umbrella term

MISSED LISFRANC

• Collapse of arch, Broadening

• Pain

• Arthritis

DIAGNOSIS

• Plantar Ecchymosis

DIAGNOSIS

• Wt Bearing both feet X-ray

• AP, Lat, Medial Oblique(True AP)

DIAGNOSIS

TREATMENT

• Rigid Fixation, Immobilization

ACUTE TA RUPTURE

• Indications for Surgery

• Athlete

• Young age, wants to return to normal activities early

TA RUPTURE

• Myotendinous junction tears is a contraindication for

Repair.

MIS

• Diabetics

• PVD

Achillon

CALCANEAL FRACTURE

ORIF

• GOALS:

• Height

• Neutral alignment (No Varus Valgus)

• Articular congruity

• Correction of Broadening.

• Step 1: Flip the lateral wall/ Remove it.

STEPS OF CALCANEAL

FRACTURE ORIF

• Step 2: Correct Heel Varus, Height

• Step 3: Reconstruct Anterior Calcaneus

• Step 4: Reduce the Posterior Facet

• Step 5: Replace the lateral wall, Fix it.

• Allgower Donati Sutures

“Bag Of Bones” Type

Fracture

• Get Height, Width

SMALL TOPICS

ANKLE SPRAINS

Treatment is Conservative for All.

COMPARTMENT

SYNDROME

• No role after 24 Hours

• Never elevate above Heart level.

THANK YOU