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open reduction, internal fixation
2%
43/2614
excisional biopsy
6%
164/2614
continue running with a molded orthotic
45/2614
protected weightbearing with crutches, with slow return to running
89%
2338/2614
percutaneous Kirschner wire fixation
0%
10/2614
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The radiographs show a diaphyseal stress fracture of the 3rd metatarsal with obvious callus formation and good alignment of the bone. These are coined a march fracture and occur in the 2nd, 3rd and 4th metatarsals, with 2nd being the most common. The cited reference indicates that a technetium-99 bone scan is the most useful diagnostic imaging modality, although CT and MRI can also be used. Treatment of this consists of 4-6 weeks of rest with gradual return to pre-injury activity level. The other treatments are not appropriate for this scenario. Illustration A shows the periosteal reaction usually seen with these injuries.
4.2
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