![]() ![]() Consider reduction if significantly angulated.Other phalangeal fractures (including distal phalangeal fractures of the big / 1st toe)Īngulated Salter-Harris II fracture of 5th proximal phalanxĭorsally displaced transverse fracture of neck of 3rd proximal phalanx Darco Shoe non-weight bearing with crutches and follow up in Fracture Clinic in 1 week.Phalangeal (Toe) Fractures Open and intra-articular fractures These intra-articular fractures are managed in a below knee backslab non weight bearing with crutches and Fracture clinic follow-up in 1 week. It is important to differentiate avulsion fractures of the base of the fifth metatarsal with Jones fractures which involve the 4th and 5th inter-metatarsal joint.CAM boot weight bearing as tolerated with Fracture Clinic follow up in 1 week.1Īvulsion fracture at the base of the fifth metatarsal (insertion of peroneus brevis)įracture of base of 5th metatarsal follow inversion injury Minimally displaced oblique of the 5th metatarsal Metatarsal fractures Undisplaced metatarsal fractures 1 Tarsometatarsal fractures (Lisfranc disruption) Avulsion fractures of the navicular or cuboid Controlled Ankle Motion (CAM) boot weight bearing as tolerated with GP follow up in 7-10 days. Midfoot fracturesīe wary of compartment syndrome in major midfoot fractures. Talar dome fracture – looks simple on plain X-ray but CT shows multiple intra-articular bony fragments. Below knee backslab non weight bearing with crutches and follow up in the Orthopaedic Fracture clinic in 7 days.Minimally displaced talar and extra-articular calcaneal fractures Refer to Orthopaedic team (high risk of avascular necrosis). ![]() A CT scan may be indicated in talar fractures, intra-articular calcaneal fractures, severe crush injuries or suspicion of Lisfranc injury.įor general assessment and management, see Fractures - Overview.If the calcaneus is tender, dedicated axial calcaneal views must be requested as calcaneal fractures may not be visible on standard views.If there is midfoot tenderness, look carefully at the joint between the medial cuneiform and 2nd metatarsal base for a Lisfranc fracture as findings can be subtle.A foot X-ray should have dorsopalmar, oblique and lateral views.Localised pain, swelling and tenderness with reluctance to weight bear.In these cases, compression fractures of the spine should also be considered. Calcaneal fractures occur after a fall from a height landing on the heels.Tarsal fractures are uncommon in isolation and are usually seen in crush injuries.Crush injuries, stubbing of toes, kicking and tripping.Clinicians should also consider the local skill level available and their local area policies before following any guideline. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinical common-sense should be applied at all times. They are not strict protocols, and they do not replace the judgement of a senior clinician. They also found progressive intra-articular displacement both preoperatively and postoperatively and recommend close radiographic follow-up of these fractures.These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. J Pediatr Orthop 34:144–149, 2014) found most patients required open reduction through a dorsal approach to the MTP joint and often found a periosteal flap of tissue in the physis which prevented a successful closed reduction. Another case series with ten patients published in 2014 (Kramer et al. A case series with four gymnasts with Salter-Harris (SH) III and IV injuries that all underwent open reduction and pin fixation with good outcomes has also been described (Perugia et al. Most of these fractures are Salter-Harris III or IV injuries. Reduction is recommended if the great toe proximal phalanx joint surface is displaced more than 2–3 mm or 25% of the joint surface is involved. Displaced intra-articular fractures in older children can be treated often with closed reduction, open reduction if needed, and percutaneous pin or screw stabilization for 4–6 weeks. A case series of hallux fractures found that soccer was the most common mechanism and 86% of children were treated non-operatively (Petnehazy et al. A common treatment regimen is weight-bearing as tolerated often in a stiff-soled shoe until the patient is comfortable ambulating in their regular shoes. Treatment of most of these injuries is non-operative with symptomatic treatment. Phalanx fractures of the toes are fairly rare injuries in children. ![]()
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