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This week’s New Yorker (our program’s most widely-read non-EM journal) has a fun article about Jones fractures and fifth metatarsal avulsions. Apparently, the latter are exceedingly common on Martha’s Vinyard in the summer. And there’s just one orthopedist on that island, to see all of them. There’s more below, but a more scholarly review of mifth metatarsal fractures and avulsions can be found at Wheeless’ Orthopedic Dictionary, online. They’ve got Xrays and differentials and more than Tintinalli, so check it out.   

The metatarsal fracture was first diagnosed in 1902, by the surgeon Sir Robert Jones, who had hurt his foot at a garden party while skipping around a Maypole. The Jones fracture, as it came to be called, occurs near the ankle end of the bone, and befalls dancers and soccer players (the metatarsal is known in England as “the Beckham bone”); the Vineyard fracture, meanwhile, is an avulsion fracture—the ankle twists, jerking the connecting tendon and a piece of bone away from the foot—and afflicts an athlete of a different sort. “Many of them are people who are getting off their decks, usually after dinner, usually after a couple of glasses of wine, and the steps are not quite so easy to negotiate,” Monto said the other day, from his office in West Tisbury.

…If the epidemic is indeed attributable to some regional lack of coördination, then Vineyarders have taken oafishness to almost artistic heights. “It’s amazing the creativity with which people are able to generate these injuries,” Monto said, having seen three new cases that day. Memorable methods include stepping back while taking photographs, engaging in jumping sports, walking on uneven streets, wearing clogs or sandals, playing soccer after a few beers, slipping on grass, riding a bike after several years’ hiatus, and trying to stop your boat from hitting the dock with the edge of your foot.

…The good news, for stumblebums in other locales, is that the injury doesn’t necessarily require any care at all. The pain, if you can stand it, feels something like walking on a peanut. Often, the fracture heals itself. “Especially in New York, where you can’t see a doctor for five weeks,” Monto said. “By the time you can get in there, you probably just say ‘Fine,’ and skip the appointment.”

Posted on Sunday, August 20th, 2006 at 7:19 pm by Nick. Filed under Orthopedics, Journal Club.
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