The Ottawa Ankle Rules can be used to localise the exact area of pain. Outcome Measures ДЄ history of the injury is taken, such as mechanism, immediate pain levels, and swelling. Other imaging methods are recommended such as MRI, CT Scan or scintigrams.

Avulsion fractures can sometimes be overlooked or where an injury to the 5th metatarsal occurs together with an ankle sprain. Дiagnostic Procedures ДЄn X-ray may be ordered by the surgeon. Unlike a DancerвЂ™s fracture a Jones fracture may not heal and often requires surgery. A Jones fracture occurs as a result of a stress fracture to the 5th metatarsal, due to repetitive loading of the outside part of the foot from the patientвЂ™s underlying foot pattern or lower extremity alignment.History of the injury will be similar to that of an ankle sprain (plantarflexor inversion). If an avulsion fracture is present, there will be immediate pain over the outside aspect of the foot and associated with significant swelling and localised tenderness over the 5th metatarsal. Bruising may develop and the patient will have difficulty walking or weight-bearing on the ankle. Pain is usually felt in the ankle immediately post-injury with an immediate onset of swelling. Symptoms of an ankle avulsion fracture are very similar to an ankle sprain and it is very difficult to differentiate without an X-ray or an MRI scan. 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 BotteвЂ™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)ДЇigure1: source: Epidemiology/ Etiology ДҐ 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.Д¬linically 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 PresentationДefinition/Description: ДЄn avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment.

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