Metatarsal Fracture 825.25 S92.309A

synonyms: metatarsal shaft fracture

Metatarsal FractureICD-10 

• S92.301A - Fracture of unspecified metatarsal bone(s), right foot, initial encounter for closed fracture
• S92.302A - Fracture of unspecified metatarsal bone(s), left foot, initial encounter for closed fracture
• S92.309A - Fracture of unspecified metatarsal bone(s), unspecified foot, initial encounter for closed fracture

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

Metatarsal FractureICD-9

• 825.25 (closed fracture of metatarsal bone)
• 825.35 (open fracture of metatarsal bone)

Metatarsal FractureEtiology / Epidemiology / Natural History

• Untreated displaced fractures (espcially sagittal plane angulation) can lead to transfer metatarsalgia and chronic pain.

Metatarsal FractureAnatomy

• 1st MT: shorter and wider; bears 1/3 of body weight via tibial and fibular sesamoids. Tibialis anterior insertion provides varus/supination/elevation forces; peroneous longus insertion provides valgus/pronationdepression forces.
• Lesser MT's: bear 1/6 body weight each.

Metatarsal FractureClinical Evaluation

• Pain, swelling in the forefoot.
• High energy injuries can result in compartment syndrome
• Document NV exam.

Metatarsal FractureXray / Diagnositc Tests

• Xray: A/P, Oblique, Lateralfoot views generally demonstrate fracture.
• CT: consider if associated midfoot fractures are possible.

Metatarsal FractureClassification / Treatment

• Nondisplaced 1st metatarsal Fracture= NWB cast for 6 wks.  CPT 28470-closed treatment without manipulation.  CPT-28475-closed treatment with manipulation.
• Displaced 1st metatarsal Fracture= ORIF, generally fixed with plates/screws. 1st metatarsal must be treated to preserve the head as a major wt bearing point.
• Nondisplaced isolated lesser metatarsal: hard soled shoe and progressive WBAT.  Displaced isolated lesser metatarsal: closed reduction and casting for 3 wks, followed by hard soled shoe and progressive WBAT. 
• Nondisplaced multiple lesser metatarsals: hard soled shoe, brief period of NWB follopwed by progressive WBAT.
• Displaced Multiple lesser metatarsals: require reduction and Kwires or ORIF
• important to metatarsal head positions

Metatarsal FractureAssociated Injuries / Differential Diagnosis

• Cuboid fracture
• Lisfranc Fracture
• Talar head fracture
• Navicular stress fracture
• Metatarsal fractures
• Jones Fracture

Metatarsal FractureComplications

Metatarsal FractureFollow-up Care

• Post-op /Initial: NWB, Hard soled shoe. Elevation.
• 7-10 Days: xray to ensure reduction is maintained. Continue hard-soled shoe, may brpgress with weight bearing depending on fracture stability, activity modifications.
• 6 Weeks: Remove k-wire. Advance weight bearing in hard-soled shoe dependent on fracture union on xrays.
• 3 Months: Resume full activities based on union. Consider bone stimulator if union not evident on xray.
• 1Yr: assess outcomes / follow-up xrays.

Metatarsal FractureReview References

• Rockwood and Green's Fractures in Adults 6th ed, 2006
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