orthopedic paper VI
Fifth metatarsal fracture caused by varus sprain
Report of 30 cases
收集我院83年以来足部扭伤经X线片确诊的第5跖骨基底部撕脱骨折30例，予以分析报导。
Thirty cases of avulsion fracture of the base of the fifth metatarsal bone diagnosed by X-ray of foot sprain in our hospital since 83 years are collected and analyzed.
临床资料 男性22例，女性8例，年龄在23至54岁，40岁以下24例，可见多发生在活动量大的中青年，致伤原因全部为行走不慎患足内翻扭伤, 单纯骨折错位不显著28 例，2 例呈粉碎型,经一般治疗或不予治疗，1~2月均可基本恢复功能。
Clinical data include 22 males and 8 females, age ranging from 23 to 54 years old, with 24 cases under 40 years old. It could be seen that most of them occurred in the young and middle-aged with high activity. All the injuries were caused by accidental walking with varus sprain. There were 28 cases with simple fracture dislocation but no significant ones. The two cases were of comminuted type. After general treatment or no treatment, the patients could basically recover to their functions within 1–2 months.
讨论
除直接暴力和开放性外伤外，对日常生活中, 自身行走不慎发生足内翻位扭伤可致骨折，往往为医患双方所忽略，常延迟数日因软组织肿胀消退而症状不减，才拍片确诊。其骨折机理为足部急促过度内翻， 腓骨短肌强力收缩牵拉，使该肌附丽点第5跖骨基底部撕脱骨折, 骨折线常呈斜形、不整、分离状态，临床上局部压痛明显,可出现皮下淤血, 较长时间的肿胀, 妨碍行走和正常活动，X线拍片即可避免漏诊。除移位和分离明显者需外翻位石膏托固定三周外，一般可不予特殊处理。适当休息2至3周, 症状消失, 即可负重行走操练, 而不必等待X线片上骨性愈合。本组30例，历经1至8年观察, 无一例遗有功能障碍, 这是因为单纯扭伤, 其外力不足以造成足部横弓及外侧纵弓的解剖学的严重紊乱或破坏。
Discussion
In addition to direct violence and open trauma, fractures caused by pronation and sprain of your foot due to careless walking in daily life are often ignored by both doctors and patients. The diagnosis is usually confirmed through radiography after a delay of several days because the symptoms do not decrease due to the disappearance of soft tissue swelling. The fracture mechanism was rapid and excessive varus of foot, and strong contraction and traction of peroneal brevis, which caused avulsion fracture of the base of the fifth metatarsal bone at the point of attachment of this muscle. The fracture lines were often in an oblique, irregular and separated state. In clinic, local tenderness was obvious, and subcutaneous congestion could occur. The swelling for a long time prevented walking and normal activities. The missed diagnosis could be avoided by X-ray radiography. In addition to the obvious shift and separation of the need to evert the cast fixed for three weeks, generally can not special treatment. After an appropriate rest for two to three weeks, the symptoms disappear and the patient can walk with load without waiting for bony healing on the X-ray film. After one to eight years of observation, none of the 30 cases in this group has been left with dysfunction, which is due to the severe disorder or destruction of the anatomy of the transverse and lateral longitudinal arches of the foot due to the simple sprain with insufficient external force.
By Mingjie Li, Wuhu Changhang Hospital
Journal of Southern Anhui Medical College 1994 Vol 13 Supplement
