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Metatarsal Fracture 825.25 S92.309A

synonyms: metatarsal shaft fracture

Metatarsal Fx ICD-10

  • S92.309A :Fracture of unspecified metatarsal bone(s), unspecified foot, initial encounter for closed fracture

Metatarsal Fx ICD-9

  • 825.25 (closed fracture of metatarsal bone)
  • 825.35 (open fracture of metatarsal bone)

Metatarsal Fx Etiology / Epidemiology / Natural History

  • Untreated displaced fractures (espcially sagittal plane angulation) can lead to transfer metatarsalgia and chronic pain.

Metatarsal Fx Anatomy

  • 1st MT: shorter and wider; bears 1/3 of body weight via tibial and fibular sesamoids. Tibialis anterior insertion provides varus/supination/elevation forces; peroneous longus insertion provides valgus/pronationdepression forces.
  • Lesser MT's: bear 1/6 body weight each.

Metatarsal Fx Clinical Evaluation

  • Pain, swelling in the forefoot.
  • High energy injuries can result in compartment syndrome
  • Document NV exam.

Metatarsal Fx Xray / Diagnositc Tests

  • Xray: A/P, Oblique, Lateralfoot views generally demonstrate fracture.
  • CT: consider if associated midfoot fractures are possible.

Metatarsal Fx Classification / Treatment

  • Nondisplaced 1st metatarsal fx = NWB cast for 6 wks.  CPT 28470-closed treatment without manipulation.  CPT-28475-closed treatment with manipulation.
  • Displaced 1st metatarsal fx = ORIF, generally fixed with plates/screws. 1st metatarsal must be treated to preserve the head as a major wt bearing point.
  • Nondisplaced isolated lesser metatarsal: hard soled shoe and progressive WBAT.  Displaced isolated lesser metatarsal: closed reduction and casting for 3 wks, followed by hard soled shoe and progressive WBAT. 
  • Nondisplaced multiple lesser metatarsals: hard soled shoe, brief period of NWB follopwed by progressive WBAT.
  • Displaced Multiple lesser metatarsals: require reduction and Kwires or ORIF
  • important to metatarsal head positions

Metatarsal Fx Associated Injuries / Differential Diagnosis

Metatarsal Fx Complications

Metatarsal Fx Follow-up Care

  • Post-op /Initial: NWB, Hard soled shoe. Elevation.
  • 7-10 Days: xray to ensure reduction is maintained. Continue hard-soled shoe, may brpgress with weight bearing depending on fracture stability, activity modifications.
  • 6 Weeks: Remove k-wire. Advance weight bearing in hard-soled shoe dependent on fracture union on xrays.
  • 3 Months: Resume full activities based on union. Consider bone stimulatorif union not evident on xray.
  • 1Yr: assess outcomes / follow-up xrays.

Metatarsal Fx Review References

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