Stewart Classification of Fifth Metatarsal Base Fractures
Introduction
- The Stewart classification helps differentiate fractures of the fifth metatarsal base, an area where Jones fractures are often misdiagnosed.
- Understanding this classification is crucial due to the high non-union rate associated with Jones fractures.
Jones Fracture
- Characterized by a high rate of non-union.
- Occurs due to the watershed area, which has poor blood supply.
Stewart Classification Types
- The classification goes in order from distal to proximal in relation to the fourth and fifth metatarsal articulation.
Type One
- Distal to the fourth and fifth metatarsal base articulation.
- Extra-articular fracture.
- Corresponds to the Jones fracture.
Type Two
- Proximal to the articulation with the other metatarsals.
- Intra-articular fracture that enters the base.
Type Three
- Avulsion fracture of the styloid process of the fifth metatarsal base.
- Occurs at the insertion point of the peroneus brevis tendon.
- It's important to know the peroneus brevis inserts at this location.
Type Four
- Common intra-articular fracture of the fifth metatarsal base.
Type Five
- Specific to children.
- Involves injury to the hypophysis of the fifth metatarsal.
Mnemonic
- Remembering the classification with the association of the name Stuart Little:
- Type one is the Jones fracture, located just outside the articulation.
- Type two is just inside the articulation.
- Type three is an avulsion type fracture where the peroneus brevis inserts.
- Type four is the combined intra-articular fracture.
- Type five is in children and related to the hypophysis.