Definition
Insufficiency fracture
- secondary to exceeding fatigue threshold
- usually of second or third MT shaft
Epidemiology
Onset of new and very intense / strenuous physical activity
- i.e. new army recruits / dancers
Women with postmenopausal osteoporosis
Association
Cavus feet
History
Pain after walking & then with walking
Swelling after activity
Examination
Tender swelling along MT shaft
Often visible dorsal swelling
X-ray
Initially normal
- may need oblique xray to diagnose
Later shows callus around fine transverse / oblique fracture
- usually midshaft or distal
- usually incomplete
- often 2nd or 3rd MT longer than 1st
Bone Scan / MRI
Show increased activity prior to xray changes
Management
Non operative
Symptomatic
- rest for 4-6 / 52
- MT dome
- may need strapping / cast / moon boot
95% union rate
- complete fracture rare
Operative
Rarely required
Dorsal approach / plate / bone graft