Central metatarsal fractures: a review and current concepts

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Traumatology

Background:

• Central metatarsal fractures (CMF) represent a significant portion of foot injuries.
• The third metatarsal is most frequently injured, often with associated fractures of adjacent metatarsals.
• Understanding metatarsal anatomy and biomechanics is crucial for effective management.

Purpose of the Study:

• To review the epidemiology, diagnosis, and treatment strategies for central metatarsal fractures.
• To highlight the importance of considering adjacent metatarsal and Lisfranc joint involvement.
• To discuss surgical techniques and factors influencing clinical outcomes.

Main Methods:

• Review of existing literature on central metatarsal fractures.
• Analysis of diagnostic approaches including clinical examination and imaging.
• Evaluation of conservative and surgical treatment modalities.

Main Results:

• Conservative treatment is indicated for fractures with minimal angulation (<10°) and translation (<3-4 mm).
• Surgical options include intramedullary K-wire fixation for simple fractures and interfragmentary screws or dorsal plating for complex/spiral fractures.
• Multiple contiguous metatarsal fractures require careful assessment of the Lisfranc articulation.

Conclusions:

• Accurate diagnosis and appropriate treatment selection are vital for optimal outcomes in central metatarsal fractures.
• Complex fracture patterns and patient factors can lead to a substantial rate of suboptimal results (up to 39%).
• Further research may refine surgical techniques and improve patient prognoses.