Review Question - QID 5211

Figure A shows an AP foot x-ray of a 2.5 year old child. The first metatarsal (Label 1) is the most common site for metatarsal fractures in children less than 5 years old.

Metatarsal fractures are common in children. They are usually minimally displaced and rarely require operative treatment. The most common location for fracture is the first metatarsal in children less than 5 years old and the fifth metatarsal in children greater than 5 years old.

Singer et al. reviewed a consecutive series of 125 patients with metatarsal fractures. They found two groups of injuries. In children less than 5 years old the most common location of injury was home; the most common mechanism was a fall from a height; the most common bone involved was the first metatarsal. In children greater than 5 years old the most common location of injury was sports; the most common mechanism was a fall from standing; the most common bone involved was the base of 5th metatarsal.

Owen et al. retrospectively reviewed 62 metatarsal fractures. They showed that in children less than 5 years old, the first metatarsal accounted for 73% of metatarsal fractures. In children greater than 5 years old, first metatarsal fractures accounted for only 12%. In addition, 20% of first metatarsal fractures went unrecognized at the initial persentation.

Figure A shows a normal AP foot x-ray of a 2.5 year old child.

Incorrect Answers:
Answers 2-5: In children less than 5 years old, the proximal first metatarsal is the most common site for metatarsal fractures. Ossification of bones in the foot can help to determine age. The lateral cuneiform will ossify by 1st year, middle cuneiform by 3rd year, and medial by 4th year.