Morphologic Analysis of the Fifth Metatarsal Stress Fracture: The Precise Coronal and Sagittal Location

Kyung Tai Lee; Ki Won Young; Young Uk Park; Hyuk Jegal; Jeong Hyun Seo3

doi:10.5763/kjsm.2016.34.2.127

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Lee, Young, Park, Jegal, and Seo3: Morphologic Analysis of the Fifth Metatarsal Stress Fracture: The Precise Coronal and Sagittal Location

Review Article

Korean J Sports Med 2016;34(2):127-131.

Published online: 20 January 2016

DOI: https://doi.org/10.5763/kjsm.2016.34.2.127

Morphologic Analysis of the Fifth Metatarsal Stress Fracture: The Precise Coronal and Sagittal Location

Kyung Tai Lee¹, Ki Won Young², Young Uk Park³, Hyuk Jegal¹, Jeong Hyun Seo3

¹Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea

²Foot and Ankle Clinic, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea

³Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

Correspondence: Young Uk Park Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5220, Fax: +82-31-219-5229 E-mail: parkyounguk@gmail.com

Received 26 August 2016 Revised 29 October 2016 Accepted 1 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

From a biomechanical standpoint, the main pathologic abnormality of fifth metatarsal stress fracture is the location where repetitive tensile stress concentrated. Decreasing tensile force in this region would be a proper treatment. Therefore, the purpose of this study is to evaluate the precise sagittal and coronal location of the fifth metatarsal stress fracture. Between June 2012 and May 2013, 38 athletes with a fifth metatarsal stress fracture were treated. To evaluate the precise sagittal location of the fracture, the entire length of the fifth metatarsal was measured and the distance from tuberosity to the fracture line was measured. To evaluate the precise coronal location of the fractures, coronal computed tomography images were obtained for incomplete fracture cases. The fracture location was classified as four quadrants. Thirty patients were classified into zone III fracture. However, the fracture is located in zone II for remaining eight cases. The median value of ratio between whole length and the distance from tuberosity to the fracture was 0.35 (range, 0.29–0.40) Among 33 incomplete fracture cases, there were 28 patients whose fracture developed in plantolateral quadrant, four patients at the lateral side and a patient for plantar side. The main pathologic abnormality is at the plantar lateral side because of the repetitive stress concentrated there.

Keywords: Metatarsal bones, Fracture, Stress

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Fig. 1.

The entire length of the fifth metatarsal was measured on a 30-degree internal oblique view. The distance from tuberosity to the fracture line was measured. The ratio between the entire length and the distance from tuberosity to the fracture (A, B) were calculated.

Fig. 2.

The fracture location was classified into four quadrants: dorsomedial, dorsolateral, plantomedial, and plan-tolateral. The quadrant was made as a reference to the line formed between the most inferior margin of the first metatarsal and the fifth metatarsal. The second line was drawn parallel to this line centered to the fifth metatarsal center. The third line was drawn perpendicular to the second line centered to the fifth metatarsal.

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