📌 How to Tell an Apophysis from a Fracture at the Fifth Metatarsal Base

https://youtube.com/shorts/ykgTMN8cCG0

 

1. Why This Distinction Matters
The fifth metatarsal apophysis is a normal secondary ossification center in children and adolescents.
A fracture, in contrast, is a pathological break that follows trauma and usually requires treatment.
Key differences include age, orientation on imaging, clinical context, and soft-tissue findings.

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2. Age and Clinical Context
Apophysis: Appears in skeletally immature patients (girls ~9–11, boys ~11–14). It is a normal developmental variant without clear trauma, sometimes presenting as overuse pain such as Iselin disease.
Fracture: Can occur at any age, especially in athletes. Typically follows an acute inversion injury with sudden pain, swelling, or ecchymosis.

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3. Radiographic Appearance
Apophysis: Shows a longitudinal or oblique radiolucent line running parallel to the 5th metatarsal shaft. Edges are smooth and it does not extend into the cubometatarsal joint.
Fracture: Appears as a transverse or oblique line that is orthogonal to the shaft. The margins are sharper and more irregular, and the line may extend into the articular surface, including avulsion or Jones/stress fracture patterns.

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4. Symptoms and Physical Findings
Apophysis / Apophysitis: Causes activity-related lateral foot pain with point tenderness but usually minimal swelling and no ecchymosis. Radiographs may be normal or show mild irregularity.
Fracture: Presents with marked tenderness, visible swelling, and often ecchymosis. Weight-bearing becomes painful or difficult.

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5. Course and Management
Apophysis (Normal Variant): No treatment is required. Symptomatic Iselin disease improves with rest, activity modification, and NSAIDs, and the apophysis naturally fuses over 2–4 years.
Fracture: Requires immobilization with a boot or cast. Jones and diaphyseal stress fractures carry a higher nonunion risk and may need surgical intervention. Accurate classification is essential.

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https://open.spotify.com/episode/2Zjh65CWfTgzsQaERYCCKl?si=5bFqkYOuSgytg1P8uFjlKw

📌 5th Metatarsal Base Fractures: Classification, Diagnosis, and Management

https://open.spotify.com/episode/7wJqd534Vmqx8y6KBSkxwB?si=4hz_MM9ESk2H2WMWN593lQ

[Lecture] 📌 Understanding the Difference: Fifth Metatarsal Apophysis vs. Fracture