Medication Summary
Analgesics (narcotics, NSAIDs) are generally the only medications needed to treat foot fractures. Administer antibiotics and tetanus prophylaxis to patients with open fractures.
Nonsteroidal Anti-inflammatory Agents (NSAIDS)
Class Summary
These agents are used most commonly for relief of mild to moderately severe pain. Effects of NSAIDs in treatment of pain tend to be patient specific, yet ibuprofen is usually DOC for initial therapy. Other NSAIDS also may be used.
Ibuprofen (Ibuprin, Advil, Motrin)
Usually DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which inhibits prostaglandin synthesis.
Narcotic Combination Analgesics
Class Summary
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures. Hydrocodone and oxycodone preparations are generally more effective and better tolerated than other narcotic-acetaminophen combinations such as those containing codeine.
Hydrocodone bitartrate and acetaminophen (Vicodin ES)
Drug combination indicated for relief of moderately severe to severe pain.
Antibiotics
Class Summary
Prophylaxis is given to patients with open fractures.
Penicillin G (Pfizerpen)
Interferes with synthesis of cell wall mucopeptide during active replication, resulting in bactericidal activity against susceptible microorganisms.
Clindamycin (Cleocin)
Lincosamide is useful as treatment against serious skin and soft-tissue infections caused by most staphylococcal strains. Also effective against aerobic and anaerobic streptococci, except enterococci. Clindamycin is used for prophylaxis in penicillin-allergic patients. Useful as treatment against streptococci and most staphylococcal strains.
Gentamicin (Gentacidin, Garamycin)
Aminoglycoside antibiotic used for gram-negative bacterial coverage. Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in patients with open fractures.
Tetanus Toxoid
Class Summary
This agent is used for tetanus immunization. Booster injection is recommended in previously immunized individuals to prevent this potentially lethal syndrome.
Tetanus toxoid adsorbed or fluid
Induces active immunity against tetanus in selected patients. Tetanus and diphtheria toxoids are the immunizing DOC for most adults and children older than 7 y. Necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product. In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is midthigh laterally.
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Fractures, foot. Proximal fifth metatarsal avulsion fracture (also termed pseudo-Jones, tennis, or dancer fracture).
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Fractures, foot. Jones fracture of the fifth metatarsal.
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Fractures, foot. Lisfranc fracture-dislocation.
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Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression.
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Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression with Böehler angle imposed. Reduced angle of 16 degrees is pathologic.
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Fractures, foot. Subtle fracture of the first cuneiform at the Lisfranc joint. Another fracture at the base of the first metatarsal is not seen here but was found on subsequent computed tomography.
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Fractures, foot. CT scan showing fracture of first cuneiform and proximal first metatarsal.
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Fractures, foot. Spiral fracture of the shaft of the fifth metatarsal. This fracture was treated conservatively with immobilization.
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Fractures, foot. Minimally displaced fracture of the distal fifth metatarsal. This fracture was treated conservatively with immobilization in a rigid flat bottom shoe.
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Fractures, foot. Two fractures of the proximal phalanx of the great toe. The fracture at the base is obvious, but the fracture at the head is more subtle. Make certain to examine every bone on the radiograph to avoid being distracted by obvious finding.
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Comminuted navicular fracture in a young drunk driver involved in a motor vehicle crash. The patient sustained no other injuries and was discharged in a plaster splint with strict nonweightbearing. The patient subsequently had a computerized tomography (CT) scan and underwent open reduction and internal fixation 9 days after the injury. A standard anteroposterior (AP) view is shown here.
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An added oblique view of this same patient with a navicular fracture was performed in the ED to help verify the absence of other significant fractures. Obtaining views that are not part of the routine foot series can be helpful and should be added when needed.
