Neck Fractures

By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

Metatarsal neck fractures are relatively common injuries. They are commonly seen in children who run barefoot and trip. They are often also seen in patients who ride on a skateboard barefooted and come off the board and hit the ground hard. These fractures can be nondisplaced or completely displaced. Fractures to the metatarsal necks can be one or more of the metatarsals.

Signs are usually relatively obvious. There are immediate swelling and pain of the affected metatarsal(s}. Discoloration either on the top or bottom of the foot is often present and difficulty moving the toes is also seen. The patient will have difficulty putting weight on the foot.

An immediate physical examination and x-rays are necessary for this injury. Nondisplaced fractures can often be treated nonweightbearing in a cast or a boot. If the fractures are displaced minimally they can be similarly treated in a cast or boot. Injuries that are nondisplaced usually take 6-8 weeks to heal. It is always best to be nonweightbearing during the healing process.

Displaced fractures often require closed or open reduction and pin or plate fixation. Most of these fractures can be manipulated with a minimal surgical procedure and pins placed through the skin the skin through the fracture to keep the fracture stable during the healing process. The pins would then come out very simply and allow the patient to return back to all sports and activities. Failure to treat these injuries can cause a malunion to these fractures. This means the bone does not heal in its proper position and can cause problems with weight bearing on the ball of the foot.

Pics Below are a Displaced 5th Metatarsal Fracture treated with Temporary Minimal Invasive Percutaneous Pin Fixation with a 3-4mm incision under the fifth toe joint. The pin is removed after 12-16 weeks. The Patient is back in a show the following day and walking without the need for crutches or immobilization.

The images below are plain x-rays of an AP view and oblique view of metatarsal neck fractures of metatarsals two, three and four before and after healing

Series of 4th and 5th metatarsal fracture with reduction and temporary percutaneous fixation and then final healing

Series of Pictures of 4th and 5th met fractures Progression to Consolidation

Pediatric Displaced 5th Met Distal shaft/neck fracture

Preop Pics of the displaced fracture prior to Percutaneous Fixation and Reduction

We percutaneously put a pin across the fracture after closed reduction for 12-16 weeks. The last picture is a final after the fracture is healed and the pin is removed.

Preop and Postop Fracture with cerclage wire and pin fixation