Displaced, rotated fractures of 4th/5th MT shafts. Treated by mini-fragment plating
Shaft fractures are usually caused by twisting forces.
O’Malley described a series of 35 shaft fractures in ballet dancers.
Shaft fractures make up 3% of Konkel’s general series and 7% of Clapper’s in naval personnel.
In O’Malley's series of 35 shaft fractures in ballet dancers, most were treated with soft dressings and all united. No other large series of shaft fractures has been reported.
The RICE regime seems appropriate for these fractures normally, with a plaster shoe for comfort in a few patients.
If there is angular or rotational deformity which might interfere with shoewear we would consider fixation; we prefer mini-fragment plates although wires may be successful.
Fracture of the neck in a professional dancer. Treated with the RICE regime.
Head + neck fractures
Fractures of the head and neck made up 24% of Konkel’s series, although some of these were combined with distal shaft fractures. The average age was 48, and all united with non-surgical treatment.
Few of these fractures have been reported, and there is not enough data to determine best treatment.
Like shaft fractures, we use the RICE regime normally, with a plaster shoe for comfort in a few patients and fixation for significant deformity.