Answers 

What does the image show? The case image shows a Jones fracture within the cortex near the base of the 5th metatarsal bone (Note: this is not a dancer’s fracture). The metal foreign body was from a prior surgery.

What should you do next? Splint the patient, make non-weight-bearing, and provide crutches and orthopedic follow-up.

Discussion

Metatarsal fractures are fairly common injuries. By far the most common is the dancer’s fracture, which is an avulsion injury to the base of the 5th metatarsal bone, so named because of its association with ballet dancing.  It is typically treated with only a cast shoe and crutch use as needed. Outcomes tend to be good.

A less common injury, but more difficult to treat, is the Jones fracture, which is slightly more proximal within the 5th metatarsal. Healing may be poor due to less vigorous blood supply, and therefore treatment is with 6 weeks of casting and not infrequently surgery if needed due to poor healing.

Stress fractures are easy to miss early in the course because they may not be visible on plain films for more than 3 weeks. If there is significant concern, immobilization with delayed imaging can be done.  Alternatively, an outpatient bone scan or MRI may pick up these fractures earlier.

Related Articles

See the table for more information. Other types of metatarsal fractures not covered here include Lisfranc injury, among others.

Table. Metatarsal fractures

Dancer’s fracture Avulsion fracture of 5th metatarsal base, usually from inversion mechanism

Treatment

Cast shoe, crutch, weight bearing as tolerated.
Make sure it is not a Jones fracture, as treatment is very different.
Jones fracture 5th metatarsal cortical fracture >15 mm from base and <15 mm from tuberosity.

Treatment

Short leg cast for at least 6 weeks, non-weight-bearing, (surgery).
Risk of non-union.
Stress fracture X-rays often normal for first 3 weeks, but may show periosteal elevation. May need bone scan.

Brady Pregerson, MD, is an emergency physician at Cedars-Sinai Medical Center in Los Angeles and at Tri-City Medical Center in Oceanside, California.

Reference

Pregerson B. Emergency Medicine1-Minute Consult Pocketbook. 5th ed. EMresource.org; 2017.