March Fracture

 

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

 

Second Metatarsal Stress Fracture

 

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

 

Second MT Stress Fracture Bone Scan

 

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