Metatarsal and phalanx fractures

　　The causes of metatarsal and phalanx fractures are divided into two types:

　　1. The more common cause is direct violence

　　Mostly caused by heavy objects striking the foot back, rolling, inward sprain of the foot, or kicking hard objects by mistake.

　　2. Also, some fractures are caused by cumulative fatigue damage

　　Long-term, repeated, and mild direct or indirect injuries can cause a specific part of the limb to fracture, such as the second and third metatarsal fractures due to long-distance marching.

　　Due to the characteristics of the location of metatarsal and phalanx fractures, they are relatively easy to treat, generally less complications occur, but if not treated in time or not paying attention to care, may occur healing deformity. At the same time, patients with metatarsal and phalanx fractures should also pay attention to timely functional exercise to avoid functional disorders. Malunion may be due to poor reduction of fractures, unstable fixation or early removal of fixation, influenced by muscle traction, limb weight and inappropriate weight-bearing.

　　The main manifestations of this disease are foot pain, swelling, and deformity, but the manifestations of metatarsal fractures in different parts are also slightly different:

　　1. Avulsion Fracture at the Base of the Fifth Metatarsal Bone:The fibularis brevis muscle is attached to the base tubercle of the fifth metatarsal bone. Severe inward sprain of the foot can cause crack fractures or complete avulsion fractures. When taking X-ray photographs, attention should be paid to distinguishing them from the normal epiphyses of children.

　　2. Marching fractures:Less common, occurring during long-distance walking, at the neck or shaft fractures of the second and third metatarsal bones, or in the tibia, generally without displacement, also known as fatigue fractures. Fractures often occur unintentionally, without a history of trauma, with mild symptoms, only with slight pain in the early stage of the affected foot, slight swelling locally, feeling of fatigue and discomfort in the foot, and sometimes more bone spurs are found.

　　1. Fractures often have some sequelae

　　Formed by many reasons. Inevitable sequelae caused by fractures themselves, such as bone ischemic necrosis and bone development disorders caused by epiphyseal injuries, are currently particularly difficult to prevent. Other sequelae such as non-union of fractures, malunion, joint dysfunction, delayed onset neuritis, and spontaneous tendon rupture can all be prevented or their severity reduced to varying degrees.

　　2. Patients with this disease also need to pay attention to functional exercises.

　　For patients with simple fractures, no plaster cast fixation is required after surgery, and active functional exercises of the affected toe can be started the next day. For patients with tendinous injuries, functional exercises can be started after 3-4 weeks of plaster cast fixation.

　　X-ray examination is of great value for the diagnosis and treatment of fractures:

　　All suspected fractures should undergo routine X-ray examination, which can reveal incomplete fractures, deep fractures, intra-articular fractures, and small avulsion fractures that are difficult to detect clinically. Even if the fracture is already evident clinically, X-ray examination is still necessary and can help understand the type and specific situation of the fracture, which is of guiding significance for treatment.

　　X-ray films should include anteroposterior and lateral views, and must include adjacent joints. Sometimes, oblique, tangential, or contralateral corresponding部位的 X-ray films may need to be taken. After carefully reading the X-ray films, the following points should be identified:

　　1. Whether the fracture is traumatic or pathological.

　　2. Whether the fracture is displaced and how it is displaced.

　　3. Whether the fracture alignment is satisfactory and whether it needs to be corrected.

　　4. Whether the fracture is fresh or old.

　　5. Whether there is adjacent joint or bone injury.

　　Firstly, what foods are good for fracture patients?

　　1. High-energy, high-protein diet:It is helpful for restoring vitality, but it is advisable to eat it after 2 weeks after the fracture. In the early stage of the fracture, it is advisable to have light food.

　　2. Vitamin D:If fracture patients are always indoors and cannot get enough sun exposure, they are prone to a lack of vitamin D. Therefore, after a fracture, it is advisable to eat more foods rich in vitamin D (such as fish, liver, egg yolks, etc.) and try to get more sun exposure.

　　3. Vitamin C:Fruits rich in vitamin C include hawthorn, fresh jujube, kiwi, strawberry, longan, lychee, tangerine, etc., and vegetables include milk vetch (grass head), chili, bell pepper, rapeseed, cauliflower, broccoli, kohlrabi (soup vegetable), bitter melon, watercress, green cauliflower, and green amaranth, etc.

　　4. Water:After a fracture, due to prolonged sitting and inactivity, constipation is easy to occur, and at this time, it is advisable to drink more water to ensure the smoothness of the intestines.

　　Secondly, what foods should fracture patients avoid?

　　1. Bone broth:Many people believe that bone broth can supplement calcium, but in fact, the calcium in the bones cannot be absorbed directly by humans. The main nutrients in bone broth are collagen, and eating more collagen is beneficial to fracture patients, but it is not advisable to eat too much collagen in the first 1-2 weeks after a fracture because it is too greasy and may cause blood stasis, affecting recovery.

　　2. Calcium supplementation:Although calcium is an important component of bones, supplementing calcium is not beneficial for the treatment of fractures and may even cause an increase in blood calcium levels. If fracture patients do not have a calcium deficiency, they can promote the absorption of calcium by the body and accelerate the healing of broken bones by strengthening functional exercises, and should not supplement calcium blindly.

　　3. Indigestible foods:Due to long-term rest at home and the swelling and pain at the injury site, fracture patients often have a poor appetite. Eating too much nutritious and greasy food will not only make you feel even more uncomfortable, but may also cause constipation. Therefore, after a fracture, it is advisable to eat more foods that are easy to digest and defecate, and to avoid eating foods that are easy to cause bloating or indigestion, such as taro, lotus root, glutinous rice, etc.

　　4. Sugar:Excessive intake of sugars after a fracture can lead to excessive calcium loss, which is not conducive to the recovery of fracture patients. Too much sugar can also reduce the content of vitamin B1 in the body, and a deficiency of vitamin B1 will greatly reduce the activity of nerves and muscles, affecting the recovery of function.

　　5. Sanqi Tablets:Taking Sanqi tablets in the early stage of fracture can constrict local blood vessels and treat fracture hemorrhage. However, after one week of fracture recovery, the bleeding has stopped, and fresh blood supply is needed at the fracture site to promote rapid recovery. If Sanqi tablets are still taken at this time, it will cause the blood vessels to remain in a state of constriction, resulting in poor blood circulation and being detrimental to fracture healing.

　　(The above information is for reference only, please consult a doctor for details)

　　1. Avulsion Fracture at the Base of the Fifth Metatarsal Bone:The peroneus brevis muscle is attached to the tuberosity at the base of the fifth metatarsal bone. Severe foot inversion sprains can cause fissure fractures or complete avulsion fractures, and X-ray photographs should be noted to distinguish them from the normal epiphyses of children.

　　Treatment Methods:Generally without displacement, can be immobilized with adhesive bandage, bandaged with a bandage, and immobilized with a plaster boot (with a rubber heel that can be walked on) for about 6 weeks. Other metatarsal base fractures without displacement can also be treated in the same way.

　　2. Fractures at the necks of the second, third, fourth, and fifth metatarsal bones:If there is displacement, the affected toe should be manually realigned and a short leg plaster cast should be applied to immobilize it, otherwise the deformity after realignment will affect walking. If realignment is not successful, surgical realignment and pin fixation can be performed.

　　3. Marching Fracture:Less common, occurs during long-distance walking, at the necks of the second, third metatarsal bones, or shaft fractures, and can also occur in the tibia. Generally without displacement, also known as fatigue fractures. Fractures often occur without being noticed, without a history of trauma, with mild symptoms, only early pain in the affected foot, slight swelling locally, a feeling of foot fatigue and discomfort, and sometimes more callus formation is found.

　　Treatment Methods:Take appropriate rest, use arch support early, and immobilize and bandage with plaster or adhesive bandage for about 3 weeks to prevent excessive callus formation. Later, you can use arch pads (transverse and longitudinal arch pads) to distribute gravity until the symptoms disappear. There will be no aftereffects after healing.

　　If there is a fracture of the phalanx, the wound should be cleaned to prevent infection. If there is no displacement, the affected toe should be bandaged and immobilized locally. If there is displacement, the affected toe should be manually realigned and immobilized in the flexed position.