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Occupational Medicine9 papers

Open fracture metatarsal neck

Last edited: 4/15/2026

Overview

Open fractures involving the metatarsal neck typically result from high-energy trauma and pose significant risks of infection and nonunion due to compromised blood supply. 1

Diagnosis

  • Clinical Presentation: History of high-energy trauma, visible deformity, and signs of soft tissue injury.
  • Imaging: Radiography essential for initial assessment; CT may be needed for complex fractures to assess comminution and bone-loss 1.
  • Classification: Gustilo-Anderson classification system used to grade severity based on soft tissue injury extent 1.

    • Management

  • Initial Stabilization: Hemodynamic stabilization, tetanus prophylaxis, and broad-spectrum antibiotics (e.g., cefazolin or an equivalent) to cover infection risk 1.
  • Debridement: Early surgical debridement to remove devitalized tissue and foreign bodies 1.
  • Fixation: Open reduction and internal fixation (ORIF) with appropriate implants (e.g., screws, plates) to stabilize the fracture 1.
  • Soft Tissue Coverage: Delayed primary closure or skin grafting if extensive soft tissue damage 1.
  • Antibiotics: Continued antibiotic therapy tailored based on culture results and local protocols 1.
  • Follow-Up: Regular monitoring for signs of infection, delayed union, or nonunion 1.

    • Special Populations

  • Pediatrics: Not addressed in provided abstracts 1.
  • Elderly: Not specifically discussed; however, comorbidities may complicate healing and management 1.
  • Comorbidities: Presence of diabetes or peripheral vascular disease increases risk of complications such as infection and delayed healing 1.

    • Key Recommendations

  • Perform early surgical debridement and appropriate fixation to stabilize metatarsal neck fractures 1 (Evidence: Strong).
  • Initiate broad-spectrum antibiotics immediately post-injury and tailor based on culture results 1 (Evidence: Strong).
  • Utilize imaging (radiography, CT) to accurately assess fracture complexity and guide surgical approach 1 (Evidence: Moderate).

    • References

    1 Al-Qattan MM. Saw injuries causing phalangeal neck fractures in adults. Annals of plastic surgery 2012. link

    Original source

    1. [1]
      Saw injuries causing phalangeal neck fractures in adults. — Al-Qattan MM Annals of plastic surgery (2012)
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