What is the meaning of a remote fracture (fx) of the distal 5th metatarsal?

Remote Fracture of the Distal 5th Metatarsal: Clinical Meaning

A "remote" fracture of the distal 5th metatarsal refers to a healed or old fracture that occurred in the past, typically identified incidentally on imaging or during evaluation of current symptoms. The term "remote" in medical terminology indicates a temporal distance from the acute injury event.

Clinical Interpretation

Temporal Context

• "Remote" signifies the fracture is not acute and has already undergone the healing process, distinguishing it from recent or current injuries that would require active treatment 1
• The fracture may appear on radiographs as evidence of prior injury with callus formation, cortical remodeling, or residual deformity 1

Anatomical Location Significance

• The distal 5th metatarsal refers to the shaft or neck region of the bone, distinct from the more commonly discussed proximal 5th metatarsal fractures (Jones fractures or avulsion fractures at the base) 2, 3
• Distal 5th metatarsal fractures typically have excellent healing potential compared to proximal fractures due to better vascular supply 4, 5

Radiographic Findings of Remote Fractures

Expected Imaging Features

• Callus formation at the previous fracture site indicates healing has occurred 1
• Cortical remodeling with smooth bone contours rather than sharp fracture lines 1
• Possible residual angulation or shortening if the fracture healed with displacement 3, 6
• Absence of bone marrow edema on MRI (if performed), which would be present in acute fractures 1

Clinical Relevance

When Identified Incidentally

• No treatment is required for a remote, healed fracture unless it is causing current symptoms 3, 5
• Document the finding as part of the patient's medical history for future reference 1

When Associated with Current Symptoms

• Determine if current pain relates to the old fracture site (post-traumatic arthritis, malunion) or represents a new injury 1
• MRI can differentiate between old healed fractures and acute bone stress by identifying bone marrow edema patterns present only in recent injuries 1
• Consider stress fracture at the same location if the patient has new onset pain with activity 1

Common Clinical Pitfalls

Misinterpretation Risks

• Do not confuse a remote fracture with an acute injury requiring immobilization—check for clinical signs of acute trauma (swelling, ecchymosis, inability to bear weight) 1
• Avoid unnecessary treatment of asymptomatic healed fractures discovered incidentally on imaging 5
• Be aware that accessory ossicles or os vesalianum at the 5th metatarsal base can be mistaken for old fractures on radiographs 1

Documentation Importance

• Clearly document the fracture as "remote" or "old healed" to prevent confusion in future clinical encounters 1
• Note any residual deformity or functional limitations resulting from the healed fracture 3, 6