J Korean Foot Ankle Soc.  2022 Dec;26(4):163-170. 10.14193/jkfas.2022.26.4.163.

Ankle and Foot Injuries Accompanying 5th Metatarsal Fractures

Affiliations
  • 1Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea

Abstract

Purpose
The proximal fifth metatarsal fracture is one of the most common foot fractures. However, few studies have evaluated the associated injuries in patients with a proximal fifth metatarsal fracture. The purpose of this study was to investigate the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures and compare the incidence of these injuries based on the injury mechanisms and location of the fracture.
Materials and Methods
This retrospective study included 157 patients with a proximal fifth metatarsal fracture who underwent surgery from January 2014 to August 2021. Their medical records and radiology images were reviewed to classify and analyze the associated injuries. The proximal fifth metatarsal fractures were classified using Lawrence and Botte's classification. Injury mechanisms were divided into direct and indirect injuries. The incidence of injuries was statistically analyzed according to the injury mechanism and classification.
Results
Of the 157 patients with proximal fifth metatarsal fractures, 81 (51.6%) were diagnosed with foot and ankle joint injuries. The incidence of foot injuries was 65.4%, that of ankle joint injuries was 19.8%, and of both foot and ankle joint injuries was 14.8%. In patients with direct injuries, the incidence of foot and ankle joint injuries was 82.5% and that of indirect injuries was 41.0%. Statistical differences were observed between the incidence of direct and indirect injuries (p<0.001). The incidence of injuries, according to Lawrence and Botte’s classification, was 54.9% (Zone I), 41.2% (Zone II), and 50.0% (Zone III) respectively. However, there were no statistically significant variations in the locations of the proximal fifth metatarsal fractures (p=0.051).
Conclusion
In this study, the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures was found to be high. Therefore, a careful physical examination and appropriate radiological evaluation are recommended for patients with such fractures.

Keyword

Fractures; Bone; Foot bones; Foot injuries; Foot

Figure

  • Figure 1 Lawrence and Botte’s classification of proximal fifth metatarsal fracture (Zone I, II, and III).

  • Figure 2 (A) Coronal image of T2-weighted magnetic resonance imaging (MRI) of Lisfranc injury (arrow). (B) Axial image of contrast-enhanced T1-weighted MRI of calcaneocuboid joint ligament injury (arrow). (C) Axial image of T2-weighted MRI, rupture of anterior talofibular ligament (arrow). (D) Coronal image of T2 weighted MRI, rupture of calcaneofibular ligament (arrow).

  • Figure 3 Venn diagram of multiple associated injury. (A) Multiple injuries of foot and ankle joint. (B) Multiple injuries of foot. (C) Multiple injuries of ankle joint. CC: bifurcate or calcaneocuboid joint ligament injury.

  • Figure 4 Percentage of ankle fracture, ankle joint ligament injury, Lisfranc injury, calcaneocuboid joint ligament injury according to Lawrence and Botte’s classification of proximal fifth metatarsal fracture (Zone I, II, and III). CC: bifurcate or calcaneocuboid joint ligament injury.


Reference

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