What is the diagnosis?

2nd - 5th metatarsal fractures. 

• Pearl: While there is a fracture of the 5th metatarsal, this is not a Jones fracture. 

What are the complications?

In general metatarsal fractures heal quite well. Even mild displacement of the fractures do well without much manipulation. That being said with metatarsal fractures you should consider these injuries in your differential and be sure to rule them out due to their difference in management and prognosis: 

• Jones fracture: base of the fifth metatarsal in watershed area

• LisFranc injury: damage to ligaments maintaining stability in the midfoot

• Stress injury: associated with repeated load

•  Pearl: Read more on these injuries here

What is the management in the ED?

If significantly displaced, consider reduction with traction placed on all of the toes involved. Otherwise splinting and follow up in the clinic is appropriate [1]. Consider a post-op shoe and crutches until follow-up rather than a full splint.

• Pearl: With multiple fractures, consider a CT scan to better evaluate for a LisFranc injury

What is your disposition?

These patients can be discharged home with outpatient follow up. Many of these injuries can be managed by their PCP or Sports Medicine if non-displaced. 

When do you consult Orthopedics?

If there is significant sagittal displacement, open injuries, or multiple metatarsal fractures, then Orthopaedic consultation is recommended as these may require surgical intervention [2].