central-metatarsal-fractures11.ppt.pptVIP

* * Dan Preece DPM, PGY-1 Stress Fx Frequency /Distribution: -second metatarsal 52% -third metatarsal 35% -first metatarsal 8% -fourth and fifth metatarsals 5% **shorter first metatarsal of Mortons foot leads to a higher risk of second metatarsal stress fractures 2: Leabhart J: Stress fractures of the calcaneus. J Bone Joint Surg Am 41:1285-1290, 1959. 1: Drez D Jr, Young J, Johnston R, Parker W: Metatarsal stress fractures. Am J Sports Med 8:123-125, 1980 Factors that can increase the risk of fractures (and stress fractures: -cavus foot conformation -long second metatarsal (e.g. Mortons foot) -metatarsus adductus -amenorrhea (hypoestrogenism) -hyperthyroidism -osteoporosis -medications -tobacco -alcohol abuse -nutritional problems -anemic disorders -training errors -poor footwear -improper athletic technique 3: Daffner R, Pavlov H: Stress fractures: Current concepts. Am J Radiol 159:245-252, 1992. Etiology and Description of Stress Fractures: - Microfractures ? Stress Reactions ? Cortical Fracture. - Stress fxs occur by cyclic loading that does not exceed the ultimate breaking limits of plastic deformation of bone. - One possible cause of stress fracture is muscle fatigue, which decreases shock-absorbing capacity of the extremity. - Repetitive force exerted by a muscle on bone 3: Daffner R, Pavlov H: Stress fractures: Current concepts. Am J Radiol 159:245-252, 1992. Biomechanical Causes of Metatarsal Stress Fxs: Dorsal strains are significantly reduced by contraction of the plantar flexory musculature. - Fatigue of these muscles during strenuous or prolonged running may result in decreased dissipation of forces by the musculature and increased exposure of the metatarsals to stress. 4: Brukner P, Bradshaw C, Khan KM, et al. Stress fractures: a review of 180 cases. Clin J Sport Med. 1996;6(2):85–9. Clinical Presentation of Stress Fxs: - Metatarsal stress fxs have a much faster onset than similar injuries of th