Unlike the non-operative treatment of a lateral ligament rupture, non-operative treatment of avulsion fractures does not yield satisfactory results. The characteristics of an avulsion fracture differ from those of a ligament rupture. Zone 3 fractures refer to proximal diaphyseal fractures, distal to the fourth and fifth metatarsal base articulation caused by excessive bearing of the region or chronic overloading as in stress fractures Characteristics/Clinical Presentation Zone 2 fractures refer to the fractures at the metaphysis-diaphysis junction, extending into the fourth-fifth intermetatarsal facet, caused by forced forefoot adduction with the hindfoot in plantar flexion. In the Zone 1 fracture, during the foot inversion, the forces exerted by peroneus brevis or lateral band of the plantar fascia cause avulsion fracture of tuberosity with or without the involvement of the tarsometatarsal articulation. According to Lawrence and Botte’s Classification, three types of proximal fifth metatarsal fractures based on the mechanism of injury, location, treatment options, and prognosis. A twisting injury to the ankle and foot may cause an avulsion fracture at any of these locations. The typical cause of injury is an inversion of the foot, generating tension along with the plantar aponeurosis insertion. Due to the high traction forces by these structures, tuberosity avulsion fractures commonly occur in an inversion injury (between the red and purple areas)įigure1: source: Epidemiology/ Etiology ĥ to 6% of all fractures in primary settings, a yearly incidence of approximately 67 in 100,000 accounts for fifth metatarsal fracture. Peroneus Brevis attaches at the lateral side of the tuberosity (red area in figure 1), with peroneus tertius attaching at the dorsal side of the most proximal compartment of the metaphysis. Taking the example of avulsion fractures at the 5th metatarsal It is divided into 3 parts: the tuberosity, the metaphysis, and the head. It can occur at numerous sites in the body, but some areas are more sensitive to these types of fractures than others, such as at the ankle which mostly occurs at the lateral aspect of the medial malleolus or in the foot where avulsion fractures are common at the base of the fifth metatarsal, but also at the talus and calcaneus.Ĭlinically Relevant Anatomy: This occurs as tendons can bear more load than the bone. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. 4 Characteristics/Clinical Presentationĭefinition/Description: Īn avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment.
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