Foot Case 2 ED Management

“Diaphyseal” or "metatarsal" fractures, if managed conservatively, have a high incidence of delayed union and malunion and require early orthopedic referral.  Many are managed operatively and require lengthy treatment.  These need to be splinted and made non weightbearing until follow up with orthopedics to determine definitive management.

“Avulsion” fractures are typically nonoperative fractures. These are allowed to bear weight with a CAM walking boot or hard soled shoe for approximately 2-4 weeks. If there is articular surface stepoff or the fracture is displaced >2mm, fixation may be necessary then these patients should be formally splinted and made non weightbearing with orthopedics referral.

If the fracture line seems very close to 1.5cm and it is hard to initially determine which type, treat conservatively as a “diaphyseal” or “metatarsal” fracture until follow up with orthopedics.