stress fracture of the proximal phalanx MRI indications positive bone scan hyperdorsiflexion injury with exam findings consistent with a plantar plate rupture abnormal radiographs persistent pain, swelling, weak toe push-off not recommended routinely findings will show disruption of volar plate AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. X-rays. Patients with open toe fractures or fractures with overlying skin necrosis are at high risk for osteomyelitis. Stress fractures can occur in toes. During the procedure, your doctor will make an incision in your foot, then insert pins or plates and screws to hold the bones in place while they heal. Proximal hallux. If the wound communicates with the fracture site, the patient should be referred. Metatarsal shaft fractures most commonly occur as a result of twisting injuries of the foot with a static forefoot, or by excessive axial loading, falls from height, or direct trauma.2,3,6 Patients may have varying histories, ranging from an ill-defined fall to a remote injury with continued pain and trouble ambulating. Phalanx fractures are classified by the following: Phalangeal fractures are the most common foot fracture in children. Copyright 2023 Lineage Medical, Inc. All rights reserved. Copyright 2023 Lineage Medical, Inc. All rights reserved. The proximal phalanx is the toe bone that is closest to the metatarsals. Toe fractures are one of the most common fractures diagnosed by primary care physicians. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. Physical examination should include assessment of capillary refill; delayed capillary refill may indicate circulatory compromise. If it does not, rotational deformity should be suspected. Referral is recommended for patients with first-toe fracture-dislocations, displaced intra-articular fractures, and unstable displaced fractures (i.e., fractures that spontaneously displace when traction is released following reduction). The younger the child, the more . Smooth K-wires or screw osteosynthesis can be used to stabilize the fragment.
hand fractures orthoinfo aaos metatarsal fractures foot ankle orthobullets phalanx fractures hand orthobullets fractures of the fifth metatarsal physio co uk 5th metatarsal . A stress fracture can also come from a sudden increase in physical activity or a change in your exercise routine. - See: Phalangeal Injury Menu: - Discussion: - fractures of the proximal phalanx are potentially the most disabling fractures in the hand; - direct blows tend to cause transverse or comminuted frx, where as twisting injury may cause oblique or spiral fracture; - proximal fragments are usually flexed by intrinsics while distal fragments are extended due to extrinsic compressive forces; At the first follow-up visit, radiography should be performed to assure fracture stability. The choice of immobilization device depends on the patient's ability to ambulate with the device with minimal to no pain. This content is owned by the AAFP. Referral is indicated for patients with first metatarsal fractures with any displacement or angulation. ROBERT L. HATCH, M.D., M.P.H., AND SCOTT HACKING, M.D. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which makes fractures about the physis likely. In P_STAR, 2 distraction pins are placed 1.5 cm proximal and distal to the fracture site in clearance of the distal radial physis. A 20-year-old male military recruit slams his index finger on a tank hatch and sustains the injury seen in Figure A. While many Phalangeal fractures can be treated non-operatively, some do require surgery. She is active in ballet and her pain is exacerbated with push-off and en pointe maneuvers. Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for four to six weeks. When performed on 18 children with distal radius-ulna fractures, P_STAR achieved near anatomic fracture alignment with no nerve or tendon injury, infection, or refracture. Patients with circulatory compromise require emergency referral. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Adjacent metatarsals should be examined, and neurovascular status should be assessed. Bite The Bullet, He Needs Long Term Function: Be The Hated Person - Robert Anderson, MD. Stress fractures are small cracks in the surface of the bone that may extend and become larger over time. Since the fragment is pulled away from the rest of the bone, this type of injury is called an avulsion fracture. See permissionsforcopyrightquestions and/or permission requests. (Right) X-ray shows a fracture in the shaft of the 2nd metatarsal. (SBQ17SE.89)
Examination should consist of a neurovascular evaluation and palpation of the foot and ankle. Am Fam Physician, 2003. A standard foot series with anteroposterior, lateral, and oblique views is sufficient to diagnose most metatarsal shaft fractures, although diagnostic accuracy depends on fracture subtlety and location.7,8 However, musculoskeletal ultrasonography can provide a quick bedside assessment without radiation exposure that accurately assesses overt and subtle nondisplaced fractures. Magnetic Resonance Imaging (MRI) scans. Immobilization of the distal interphalangeal joint is required for 2 weeks post-operatively, High rates of post-operative infection are common, Open reduction via an approach through the nail bed leads to significant post-operative nail deformity, Range of motion of the DIP joint in the affected finger is usually less than 10 degrees post-operatively, Type in at least one full word to see suggestions list, Management of Proximal Phalanx Fractures & Their Complications, Middle Finger, Proximal Phalangeal Head - Bicondylar Fracture - Fixation, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, PIP Fracture & Dislocation: Case of the Week - Shaan Patel, MD, Ring Finger Proximal Phalanx Fracture in 16M, Fracture of the base of proximal phalanx of 5th finger. Smith, Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004. Anteroposterior and oblique radiographs generally are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits. Patients with unstable fractures and nondisplaced, intra-articular fractures of the lesser toes that involve more than 25 percent of the joint surface (Figure 3) usually do not require referral and can be managed using the methods described in this article. Diagnosis is made with plain radiographs of the foot. Rotator Cuff and Shoulder Conditioning Program. Some metatarsal fractures are stress fractures. abductor, interosseous and adductor linked with proximal phalanx may aggravate fracture of the toe bones if these muscles get sudden pull. Indications. Patients with displaced fractures of the first toe often require referral for stabilization of the reduction. A combination of anteroposterior and lateral views may be best to rule out displacement. The reduced fracture is splinted with buddy taping. This procedure is most often done in the doctor's office. The proximal phalanx is the toe bone that is closest to the metatarsals. While celebrating the historic victory, he noticed his finger was deformed and painful. and S. Hacking, Evaluation and management of toe fractures.
As your pain subsides, however, you can begin to bear weight as you are comfortable. Avertical Lachman test will show greater laxity compared to the contralateral side. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Like toe fractures, metatarsal fractures can result from either a direct blow to the forefoot or from a twisting injury. If you need surgery it is best that this be performed within 2 weeks of your fracture. More sensitive than an X-ray, an MRI can detect changes in the bone that may indicate a fracture. Objective Evidence 2017, Management of Proximal Phalanx Fractures & Their Complications, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, PIP Fracture & Dislocation: Case of the Week - Shaan Patel, MD, Proximal Phalanx Fracture: Case of the Week - Michael Firtha, DO, Proximal Phalanx Fracture Surgery by Dr. Thomas Trumble, Ring Finger Proximal Phalanx Fracture in 16M, Fracture of the base of proximal phalanx of 5th finger. Nondisplaced fractures usually are less apparent; however, most patients with toe fractures have point tenderness over the fracture site. Content is updated monthly with systematic literature reviews and conferences. Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. Patients with closed, stable, nondisplaced fractures can be treated with splinting and a rigid-sole shoe to prevent joint movement. A common complication of toe fractures is persistent pain and a decreased tolerance for activity. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx.
The most common phalanx fractures involve the border digits, namely, the index and small finger rays (Fig. A collegiate soccer player presents as a referral to your office after sustaining an injury to the right foot, which he describes as hyperdorsiflexion of the toes. In an analysis of 339 toe fractures, 95% involved less than 2 mm of displacement and all fractures were managed conservatively with good outcomes.25, The most common mechanisms of injury are axial loading (stubbing) or crush injury. An MRI is performed and selected cuts are shown in Figures B and C. What is this patients diagnosis? It ossifies from one center that appears during the sixth month of intrauterine life. They can also result from the overuse and repetitive stress that comes with participating in high-impact sports like running, football, and basketball. Illustrations of proximal interphalangeal joint (PIPJ) fracture-dislocation patterns. See permissionsforcopyrightquestions and/or permission requests. The image shows a diagram of where these bones lie in the footthe midpoint of the proximal phalanges being where to the toes branch off from the main body of the foot. Because it is the longest of the toe bones, it is the most likely to fracture. Nail bed injury and neurovascular status should also be assessed. In one rural family practice,1 toe fractures comprised 8 percent of 295 fractures diagnosed; in an Air Force family practice residency program,2 they made up 9 percent of 624 fractures treated. Approximately 10% of all fractures occur in the 26 bones of the foot. If the bone is out of place, your toe will appear deformed. Nondisplaced or minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts with less than 10 of angulation can be treated conservatively with a short leg walking boot, cast shoe, or elastic bandage, with progressive weight bearing as tolerated. On exam, he is neurovascularly intact. If an avulsion fracture results in a large displaced fracture fragment, however, your doctor may need to do an open reduction and internal fixation with plates and/or intramedullary screws. Indirect pull of the central slip on the distal fragment and the interossei insertions at the base of the proximal phalanx, Intrinsic muscle fibrosis and intrinsic minus contracture, PIP joint volar plate attenuation and extensor tendon disruption, Rupture of the central slip with attenuation of the triangular ligament and palmar migration of the lateral bands, Flexor tendon disruption with associated overpull of the extensor mechanism. Fractures in this area can occur anytime there is a break in the compact bone matrix that makes up the proximal phalanx. Others use a cast that fixates the wrist, metacarpophalangeal joint and proximal phalanx but allows movement of the interphalangeal joints. The injured toe should be compared with the same toe on the other foot to detect rotational deformity, which can be done by comparing nail bed alignment. Treatment for a toe or forefoot fracture depends on: Even though toes are small, injuries to the toes can often be quite painful. Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head, Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach, Open reduction and lag screw fixation with 1.3mm screws through a radial approach, Placement of a 1.5-mm condylar blade plate through a radial approach, Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint. If more than 25% of the joint surface is involved or if the displacement is more than 2 to 3 mm, closed or open reduction is indicated. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. Treatment Most broken toes can be treated without surgery. There is typically swelling, ecchymosis, and point tenderness to palpation at the fracture site. Physicians should consider referring patients with fractures of the great toe that have any degree of displacement, angulation, or rotational deformity 6,24 (Figure 12). A 55 year-old woman comes to you with 2 months of right foot pain. Nondisplaced or minimally displaced (less than 2 mm) fractures of the lesser toes with less than 25% joint involvement and no angulation or rotation can be managed conservatively with buddy taping or a rigid-sole shoe. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This information is provided as an educational service and is not intended to serve as medical advice. Indications to treat proximal phalanx fractures operatively include all of the following EXCEPT: (OBQ12.49)
Management is influenced by the severity of the injury and the patient's activity level. Although referral rarely is required for patients with fractures of the lesser toes, referral is recommended for patients with open fractures, fracture-dislocations (Figure 5), displaced intra-articular fractures, and fractures that are difficult to reduce. If no healing has occurred at six to eight weeks, avoidance of weight-bearing activity should continue for another four weeks.2,6,20 Typical length of immobilization is six to 10 weeks, and healing time is typically up to 12 weeks. This joint sits between the proximal phalanx and a bone in the hand . Epidemiology Incidence Tuberosity avulsion fractures are generally found in zone 1 and do not extend into the joint between the fourth and fifth metatarsal bases (Figures 7 and 9). Follow-up radiographs may be taken three to six weeks after the injury, but they generally do not influence treatment and probably are not necessary in nondisplaced toe fractures. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. A 26-year-old professional ballet dancer presents with insidious onset of right midfoot pain which began 6 months ago. Minimally displaced (less than 3 mm) avulsion fractures typically require immobilization and support with a short leg walking boot. At the conclusion of treatment, radiographs should be repeated to document healing. And finally, the webinar will cover fixation techniques, including various instrumentation options.Moderator:Jeffrey Lawton, MDChief, Hand and Upper ExtremityProfessor, Orthopaedic SurgeryAssociate Chair for Quality and Safety, Orthopaedic SurgeryProfessor, Plastic SurgeryUniversity of MichiganAnn Arbor, MichiganFaculty: Charles Cassidy, MDHenry H. Banks Professor and ChairmanDepartment of OrthopaedicsTufts Medical CenterBoston, MassachusettsChaitanya Mudgal, MD, MS (Ortho), MChHand Surgery ServiceDepartment of OrthopedicsMassachusetts General HospitalChairman, AO NA Hand Education CommitteeAssociate Professor, Orthopedic Surgery, Harvard Medical SchoolBoston, MassachusettsAmit Gupta, MD, FRCSProfessorDepartment of Orthopaedic SurgeryUniversity of LouisvilleLouisville, KentuckyRebecca Neiduski, PhD, OTR/L, CHTDean of the School of Health SciencesProfessor of Health SciencesElon UniversityElon, North Carolina, Ring Finger Proximal Phalanx Fracture in 16M. However, if you have fractured several metatarsals at the same time and your foot is deformed or unstable, you may need surgery. In this type of injury, the tendon that attaches to the base of the fifth metatarsal may stretch and pull a fragment of bone away from the base. Referral also is recommended for children with first-toe fractures involving the physis.4 These injuries may require internal fixation. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. A 39-year-old male sustained an index finger injury 6 months ago and has failed eight weeks of splinting. Vollman, D. and G.A.
Comminution is common, especially with fractures of the distal phalanx. Taping may be necessary for up to six weeks if healing is slow or pain persists. He undergoes closed reduction and pinning shown in Figure B to correct alignment. Thank you. For several days, it may be painful to bear weight on your injured toe. Note that the volar plate (VP) attachment is involved in the . Lgters TT,
Phalanx Dislocations are common traumatic injury of the hand involving the proximal interphalangeal joint (PIP) or distal interphalangeal joint (DIP). (OBQ09.156)
Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5. The proximal phalanx is the phalanx (toe bone) closest to the leg. In some practice sites, family physicians manage open toe fractures; a discussion about the management of this type of injury can be found elsewhere.3,4 Patients also may require referral because of delayed complications such as osteomyelitis from open fractures, persistent pain after healing, and malunion. Proximal articular. While many Phalangeal fractures can be treated non-operatively, some do require surgery. Referral is indicated if buddy taping cannot maintain adequate reduction. (Right) Several weeks later, there is callus formation at the site and the fracture can be seen more clearly. 3 Patients with phalanx fractures typically present with pain at or near the site of injury, edema, ecchymosis, and erythema. Copyright 2016 by the American Academy of Family Physicians. Author disclosure: No relevant financial affiliations. Most toe fractures are caused by an axial force (e.g., a stubbed toe) or a crushing injury (e.g., from a falling object). Search dates: February and June 2015. 11(2): p. 121-3. This content is owned by the AAFP. Returning to activities too soon can put you at risk for re-injury. Treatment typically includes surgery to replace the fractured bone with an artificial implant, or to install hardware and screws to hold the bone in place. Started in 1995, this collection now contains 6407 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. This is followed by gradual weight bearing, as tolerated, in a cast or walking boot. Fractures of the talus include fractures of the neck, body, medial or lateral process, and osteochondral injuries. Patients should be instructed to apply ice, elevate the foot above heart level, and use analgesics as needed. High-impact activities like running can lead to stress fractures in the metatarsals. angel academy current affairs pdf . Differential Diagnosis The same mechanisms that produce toe fractures. Although fracturing a bone in your toe or forefoot can be quite painful, it rarely requires surgery. In many cases, anteroposterior and oblique views are the most easily interpreted (Figure 1, top and bottom). If your doctor suspects a stress fracture but cannot see it on an X-ray, they may recommend an MRI scan. A fracture of the toe may result from a direct injury, such as dropping a heavy object on the front of your foot, or from accidentally kicking or running into a hard object. Toe and forefoot fractures often result from trauma or direct injury to the bone. To minimize the possibility of future disability, the position of the bone fragments after reduction should be as close to anatomic as possible. Lesser toe fractures are about twice as common as great toe fractures.23,24 The great toe has an increased role in weight bearing and balance; thus, injury to the great toe is associated with higher morbidity.6,24, The primary goals of treating toe fractures include reestablishing and maintaining alignment, regaining range of motion, and preventing complications. Primary care physicians are often the first clinicians patients see for foot injuries, and fractures are among the most common foot injuries they evaluate.1 This article will highlight some common foot fractures that can be managed by primary care physicians. Most fractures can be seen on a routine X-ray. The nail should be inspected for subungual hematomas and other nail injuries. Foot phalanges. Patients with lesser toe fractures with angulation of more than 20 in the dorsoplantar plane, more than 10 in the mediolateral plane, or more than 20 rotational deformity should also be referred.6,23,24. Minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts (Figure 2) and fractures with less than 10 of dorsoplantar angulation in the absence of other injuries can generally be managed in the same manner as nondisplaced fractures.24,6 Initial management includes immobilization in a posterior splint (Figure 311 ), use of crutches, and avoidance of weight-bearing activities. Despite theoretic risks of converting the injury to an open fracture, decompression is recommended by most experts.5 Toenails should not be removed because they act as an external splint in patients with fractures of the distal phalanx. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. If an acute subungual hematoma is present (less than 24 hours old), decompression may relieve pain substantially. Because of the first toe's role in weight bearing, balance, and pedal motion, fractures of this toe require referral much more often than other toe fractures. Follow-up/referral. Joint hyperextension and stress fractures are less common. Your doctor will then examine your foot and may compare it to the foot on the opposite side. Because Jones fractures are located in an area with poor blood supply, they may take longer to heal.
Percutaneous Reduction and Fixation of Displaced Phalangeal Neck Fractures in Children rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. Referral should be strongly considered for patients with nondisplaced intra-articular fractures involving more than 25 percent of the joint surface (Figure 4).4 These fractures may lose their position during follow-up. 24(7): p. 466-7. Toe fractures of this type are rare unless there is an open injury or a high-force crushing or shearing injury. Thus, this article provides general healing ranges for each fracture. Even with proper healing, your foot may be swollen for several months, and it may be hard to find a comfortable shoe.
Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. A stress fracture, however, may start as a tiny crack in the bone and may not be visible on a first X-ray. Healing time is typically four to six weeks. To enhance comfort, some patients prefer to cut out the part of the shoe that overlies the fractured toe. Examination reveals a well-aligned foot with ecchymosis and swelling on the plantar aspect of the 1st MTP joint. A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for two weeks, with progressive mobility as tolerated after initial immobilization. Data Sources: We searched the Cochrane database, Essential Evidence Plus, and PubMed from 1900 to the present, human studies only, using the key words foot fractures, metatarsal, toe, and phalanges fractures. Copyright 2023 American Academy of Family Physicians. Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe. Metatarsal fractures usually heal in 6 to 8 weeks but may take longer. Repeat radiography is indicated and should be obtained one week post-fracture if there was intra-articular involvement or if a reduction was required. ORTHO BULLETS Orthopaedic Surgeons & Providers A 34-year-old male sustains the closed finger injury shown in Figure A one week ago. If you have an open fracture, however, your doctor will perform surgery more urgently. Early surgical management of a Jones fracture allows for an earlier return to activity than nonsurgical management and should be strongly considered for athletes or other highly active persons. Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students.
In some cases, a Jones fracture may not heal at all, a condition called nonunion. Most broken toes can be treated without surgery. The flexor and extensor tendons impart a longitudinal compression force, which can shorten the phalanx and extend the distal fragment [ 1 ]. (Right) The bones in the angled toe have been manipulated (reduced) back into place. Recent studies have demonstrated that musculoskeletal ultrasonography and traditional radiography have comparable accuracy, sensitivity, and specificity in the diagnosis of foot and ankle fractures9,10 (Figure 1). Three muscles, viz. The next bone is called the proximal phalanx. Metacarpal Fractures Hand Orthobullets Fractures Of The Proximal Fifth Metatarsal Radiopaedia Fifth Metacarpal Fractures Statpearls Ncbi Bookshelf Ulnar side of hand. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. All rights reserved. Concerns with delayed healing and/or high activity demands may result in your doctor recommending surgery for an acute Jones fracture as well. Proximal metaphyseal. J AmAcad Orthop Surg, 2001. Proper . The appropriate treatment depends on the location of the fracture, the amount of displacement (shifting of the two ends of the fracture), and activity level of the patient. Nondisplaced acute metatarsal shaft fractures generally heal well without complications. Abductor, interosseus, and adductor muscles insert at the proximal aspects of each proximal phalanx. Fractures of the proximal phalanx of the hallux involving the epiphysis may be intra-articular. Patients should limit icing to 20 minutes per hour so that soft tissues will not be injured. Other symptoms may include: If you think you have a fracture, it is important to see your doctor as soon as possible. Surgery may be delayed for several days to allow the swelling in your foot to go down. Toe fracture (Redirected from Toe Fracture) Contents 1 Background 2 Clinical Features 3 Differential Diagnosis 3.1 Foot and Toe Fractures 3.1.1 Hindfoot 3.1.2 Midfoot 3.1.3 Forefoot 4 Management 4.1 General Fracture Management 4.2 Immobilization 5 Disposition 6 See Also 7 References Background Bones of the foot. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. You can rate this topic again in 12 months. Referral also should be considered for patients with other displaced first-toe fractures, unless the physician is comfortable with their management. Your video is converting and might take a while Feel free to come back later to check on it. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. myAO. 2012 Oct; 43 ( 10 ): 1626-32. doi: 10.1016/j.injury.2012.03.010. The Ottawa Ankle and Foot Rules should be applied when examining patients with suspected fractures of the proximal fifth metatarsal to help decide whether radiography is needed14 (Figure 815 ). Ulnar gutter splint/cast. Based on the radiographs shown in Figure A, what is the most appropriate next step in treatment? Displaced fractures of the first toe generally are managed similarly to displaced fractures of the lesser toes. A Jones fracture is a horizontal or transverse fracture at the base of the fifth metatarsal. laceration bone talks, extensor tendon injuries hand orthobullets, flexor and extensor tendon injuries phoenix az arizona, tendon lacerations twin boro physical therapy, repair and rehabilitation of extensor hallucis longus and, extensor mechanism injury hip amp knee book, To check proper alignment, radiographs should be taken immediately after reduction and again seven to 10 days after the injury (three to five days in children).4 In patients with potentially unstable or intra-articular fractures of the first toe, follow-up radiographs should be taken weekly for two or three weeks to monitor fracture position. This usually occurs from an injury where the foot and ankle are twisted downward and inward. Fracture Fixation, Internal Bone Plates Fracture Fixation Bone Nails Fracture Fixation, Intramedullary Bone Screws Bone Wires Range of Motion, Articular Hemiarthroplasty Arthroplasty Casts, Surgical Treatment Outcome Arthroplasty, Replacement Internal Fixators Retrospective Studies Bone Transplantation Reoperation Injury .