stress fracture

Definition

Insufficiency fracture

- secondary to exceeding fatigue threshold

- usually of second or third MT shaft

Epidemiology

Onset of new and very intense / strenuous physical activity

- i.e. new army recruits / dancers

Women with postmenopausal osteoporosis

Association

Cavus feet

History

Atypical Femur Fractures

Site

Subtrochanteric

Lateral femoral shaft

Aetiology

Stress fractures

Associated with long term bisphonate use

Bisphosphonates

Black et al. NEJM 2020

- reduction of hip fracture risk v risk of atypical femur fracture

- 10 year period

Metatarsal Fractures

Indications for Surgery

1.  Displacement > 4 mm

2.  Angulation > 10^o

3.  Intra-articular

Base of 5th Metatarsal

Classification

Zone 1

- avulsion fractures

Types

1.  Dorsal lip fracture / Tuberosity fracture

- avulsion fractures

- most common

- beware avulsion T post

2.  Body fracture

3.  Stress Fractures

Body Fractures

Types

A.  Transverse fracture in coronal plane

B.  Transverse from dorsolateral to plantarmedial

C.  Central or lateral comminution