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Check for Additional Metatarsal Fractures if Second, Third, or Fourth Are Fractured

Posted on: 04/18/2008
Fractures of the metatarsal (toe) are a common childhood injury - most frequently the first and the fifth ones are affected. Children under five years old appear to break their first toe more often, while children over five were most likely to break their fifth toe, much like adults.

Several studies have been done regarding metatarsal fractures, but few have been done that target the pediatric population. The authors of this study wanted to establish the cause, location, mechanism of injury, and the age of children who were most likely to sustain such a fracture.

Researchers reviewed the cases of 125 children with metatarsal fractures, who made up 0.6 percent of all the patients who presented at their institution's emergency department, and they made up 3.2 percent of all patients who presented with fractures. Sixty percent of the patients were male. The mean age of the patients was eight and a half years old, with the younger children being mostly girls and the older children being mostly boys. Eighty-five children were over five years old. Those 85 patients had 104 fractures between them.

In reviewing the sites of the fractures, the researchers determined that 38 patients were injured outside (backyard or playground), 31 in the home, 31 while playing sports, and 15 while in school or daycare.

Among all 125 patients, there were 166 fractures - 22 patients had multiple metatarsal fractures. Those children who had fractures other than the first and fifth also had other metatarsal fractures. Seven percent of the patients (nine children) had other traumas, as well.

The authors of this study write that by knowing how, where, and why the fractures occurred, physicians are better equipped to manage the fractures. In a previous study, published in 1995, researchers stated that the most common fracture in childhood was of the fifth metatarsal. The findings of this study confirmed this finding among the children over five years old.

Of note, the authors point out the finding that if there is a fracture of the second, third, or fourth metatarsal, there are frequently other metatarsal fractures as well, while the first and fifth metatarsals were most frequently the only fractures.

References:
Georg Singer, MD, et al. A study of Metatarsal Fractures in Children. In The Journal of Bone and Joint Surgery. April 2008. Vol. 90-a. No. 4. Pp. 772-776.

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