Therapy of a metatarsal fracture
introduction
Therapy of an acute Metatarsal fracture strongly depends on the extent of the fracture and involvement of surrounding structures. In the following, the therapy is shown depending on the above-mentioned breakdown classification.
Conservative therapy
The Therapy of a metatarsal fracture can be conservative as well as surgical.
How the therapy for a metatarsal fracture works depends on which of the five Metatarsal bones broken, how the fracture formed and how severe the fracture is.
This is how you treat the Metatarsal bones II, III, IV usually conservative in the case of a broken stem.
If the bones involved in the fracture are shifted to one another or deviate from one another, this is acomplicated break" (also "dislocated fracture") And it usually has to be treated surgically, since the bone parts are returned to their healthy position (=Reduction) and must be fixed there (see operational procedures).
If the fracture is uncomplicated, however, it can be treated conservatively.
At a Fatigue fracture (For example: a fracture that occurs when the bone has been permanently overloaded) conservative therapy methods are mostly used.
These usually look like this:
First, the injured foot is used for six to eight Weeks in a cast or special shoe, which should have a hard sole. The joints are immobilized. Later a sturdy boot is sufficient for stabilization.
A bandage can be used for minor fractures Tape sufficient. In addition, the foot should be relieved and only if necessary be stress-adapted to the pain.
The patient can be given crutches to relieve the strain. Since the foot is usually swollen after a fracture, additional measures are taken to make it swell. That includes Cool and Elevate of the affected foot. In addition, the application of a Lymphatic drainage respectively.
The fracture should be healed after three months at the latest. Sport and other major loads should be avoided until this period. Afterwards or even during the healing process, physiotherapy can take place so that the muscles do not become weaker or shorten. So-called magnetic field or ultrasound therapies can be carried out for poorly healing fractures; however, these are usually not covered by the statutory health insurance.
Operative therapy methods
Screw fixation
This alone is often not enough to stabilize a metatarsal fracture. This involves inserting screws into the relevant bone in order, for example, to attach broken bone fragments to the adjacent bone.
Tension belt
These are 2 wires that are knotted together to hold two bone fragments together. This is necessary when different muscles attach to these bone fragments and pull the affected bone apart, making healing impossible.
Krischner wire
The Kirschner wires are very similar to nails. However, they are thinner, somewhat flexible and have no thread. They serve to stabilize unstable fractures. In addition, the introduction of the Kirschner wires in the metatarsal fracture is very gentle on the tissue.
External fixator
This is a temporary treatment for the metatarsal fracture until the soft tissue involved has settled and surgical treatment can follow. It is a fixation by means of a frame from the outside. This is intended to hold the break in the desired position, but is not stable in terms of movement.
Read more here External fixator.
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Soft tissue involvement
If necessary, closed fractures are brought back into normal position (repositioned). If it is an unstable closed fracture, the Metatarsal fracture through so-called Kirschner wires fixed. This can be done percutaneously and does not require open surgery. However, fractures that cannot be reduced from the outside must always be surgically brought into normal position and possibly fixed. Both open and closed fractures should be repositioned and fixed.
However, here is one Antibiotics- Prophylaxis is very important to avoid infections caused by the open metatarsal fracture. Since the soft tissue is severely affected in open fractures, only an initial reduction and antibiosis should be performed initially. After calming the soft tissue involved, the definitive therapy follows.
This usually consists of Reduction and Fixation by means of an external fixator (external fixation) or Kirschner wires. Soft tissue involvement can be a clinical emergency if it is a compartment syndrome. This must be excluded or treated within 6 hours by intracompartmental pressure measurement in order to avoid permanent nerve damage. If in doubt, all nine compartments should be relieved via one medial (from the inside of the foot) and two dorsal (from behind) incisions. In almost all cases, the Kirschner wires are removed 6 weeks postoperatively, but they can also be left in the bone.
stability
Is a single Metatarsal bones broken, fixation is often not necessary, as the fracture is usually stable. If a compartment syndrome is excluded, the Metatarsal fracture if necessary repositioned and can then conventionally with a tape bandage or an individually adapted one inlay be treated. The duration of this therapy is usually 6 weeks. Increasing pain-related stress is possible, especially on the heel. The exception to this is a fracture of the 1. Metatarsal The therapy consists of a lower leg cast with an adapted insert for approx. 3 to 4 weeks. This is followed by a slow transition to full exercise up to the 6th to 8th week. If two or more metatarsal bones lying next to each other are broken, it is one Serial fracture. These are partly unstable and must then be reduced and fixed as described above.
Here, too, the load is pain-dependent and slow. The Kirschner wires are removed approx. 6 weeks postoperatively. Dislocation fractures are reduced, and if necessary with Kirschner wires fixed. After the soft tissues have calmed down, a stable osteosynthesis is often necessary. This is done with plates or screws and thus stabilizes the bone permanent. The final osteosynthesis is followed by a lower leg cast treatment lasting at least 6 weeks. The load takes place slowly, adapted to the pain and via the heel.
localization
Of the Metatarsal fracture the base fracture is usually a dislocation fracture and is treated as such until proven otherwise. Stable fractures are reduced, unstable fractures are reduced and fixed. The treatment is carried out as described above using a lower leg cast and slow exercise. Shaft fractures are also usually not dislocated. They are also reduced and, if necessary, fixed. If the metatarsal fracture is a comminuted fracture, it is often fixed to the adjacent metatarsal bones with the help of Kirschner wires.
Subcapital fractures are usually dislocated and unstable, so they do not remain in the desired position after reduction. Thus, the fixation is by means of axially introduced Kirschner wires necessary. These are either removed after 4 to 6 weeks or completely sunk into the bone and can remain there for life. Further therapy is carried out as above by applying a plaster of paris and slowly increasing the load. Smaller fractures within the joint space are treated with a roof tile bandage. The neighboring toe is included to ensure stability. This form of association is called Buddy taping. If the broken fragment is too large, instability can result. In such a case, osteosynthesis using Kirschner wires or screws is indicated. This is followed by a plaster cast and immobility for about 6 weeks.
