Thursday, July 7, 2016

2nd to 4th Metatarsal Fracture Algorithm

1. Encounter Metatarsal pain with no displacement (w/ or w/o redness and swelling, no trauma necessary). If non-reducible displacement, surgery.
2. Get an X-ray to look for fracture.
3. If no fracture found, get an MRI or Bone Scan to look for fracture. If frx found, go to 4.
4. Prescribe rest, hard-soled rubber shoe, and analgesics. If patient returns with persistent pain, 5.
5. Cast the foot, going from distal to proximal.

Notes: Reserve surgery for Jones fractures (of 5th metatarsal), or displaced fractures. We can start conservatively since the surrounding metatarsals act as splints for metatarsals 2-4.

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