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Skeletal Radiology

, Volume 43, Issue 4, pp 467–474 | Cite as

Radiographic classification for fractures of the fifth metatarsal base

  • Alexander T. Mehlhorn
  • Jörn Zwingmann
  • Anja Hirschmüller
  • Norbert P. Südkamp
  • Hagen SchmalEmail author
Scientific Article

Abstract

Objective

Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed.

Materials and methods

A cohort of 95 healthy, sportive, and young patients (age ≤ 50 years) with avulsion fractures of the MTB5 was included in the study and divided into groups with non-displaced, primary-displaced, and secondary-displaced fractures. Radiomorphometric data obtained using standard oblique and dorso-plantar views were analyzed in association with secondary displacement. Based on this, a classification was developed and checked for reproducibility.

Results

Fractures with a longer distance between the lateral edge of the styloid process and the lateral fracture step-off and fractures with a more medial joint entry of the fracture line at the MTB5 are at higher risk to displace secondarily. Based on these findings, all fractures were divided into three types: type I with a fracture entry in the lateral third; type II in the middle third; and type III in the medial third of the MTB5. Additionally, the three types were subdivided into an A-type with a fracture displacement <2 mm and a B-type with a fracture displacement ≥ 2 mm. A substantial level of interobserver agreement was found in the assignment of all 95 fractures to the six fracture types (κ = 0.72). The secondary displacement of fractures was confirmed by all examiners in 100 %.

Conclusions

Radiomorphometric data may identify fractures at risk for secondary displacement of the MTB5. Based on this, a reliable classification was developed.

Keywords

Radiomorphometry Fracture Fifth metatarsal base Classification 

Notes

Conflict of interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Copyright information

© ISS 2014

Authors and Affiliations

  • Alexander T. Mehlhorn
    • 1
  • Jörn Zwingmann
    • 1
  • Anja Hirschmüller
    • 1
  • Norbert P. Südkamp
    • 1
  • Hagen Schmal
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Freiburg Medical CenterFreiburgGermany

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