What is metatarsal stress fracture displacement on an x-ray? Well, that is a great question, and that is what we’re talking about today on the Doc On The Run Podcast.
If you are a runner and you get a stress fracture, you are obviously trying to get back to running as quickly as possible. You are probably not really worried about what it looks like on the x-ray, but your doctor might get an x-ray to try to get a better idea of how long it is going to take you to heal or what is going to be required to get it to heal.
One of the things that shows up on an x-ray that doctors look for that we’re trying to figure out, if you have it or not, is a thing called displacement. I want to talk to you about what that really means and to help you understand what displacement really means, I have a PVC pipe, and I took it and I cut it to simulate a fracture.
Where did this idea come from? Well, I got a call from a runner, he had a stress fracture, it wasn’t healing and what he did was the right thing, and he called for a second opinion. One of the things that he didn’t understand was this x-ray report that he got. He hadn’t looked at the images, but he did look at the x-ray report and it said that he had two millimeters of displacement of the fractured metatarsal bone without angulation. And so in this episode, I’m going to try to explain to you this same way I explained to him what fracture displacement really means and how it shows up on the x-ray in a runner.
Displacement means it’s in the wrong place. It’s not where it’s supposed to be. So, if you break the bone and you have a crack and it’s barely visible on your x-ray, but the bone is not angulated, it’s not twisted, it’s not out of place, it’s not apart, it’s non-displaced. That is good because it means it’s in the right place. If it heals there everything should be fine, right? Things go bad when it’s in the wrong place.
Displacement means it’s out of place. It could just be moved apart, or it could be angulated. Either one is displacement. So, oftentimes an x-ray report will say displaced, minimally displaced with angulation of seven degrees and that would be about like that, right? Like it’s barely bent outward. Obviously if it’s angulated at 90 degrees, well that is not really going to work so good for you. So, without angulation is better in a way.
But if you think about this, if it’s angulated and it says that the part of the cortex is touching like this example and part of it is not touching like down here, well, at least it’s going to start healing here quickly, but it’s in the wrong position. So, you kind of want it in the right position. In that case, the doctor might try to put it back in place by injecting your foot to make it numb and then pushing the bone back in place and then splinting it, casting it, or putting you in a fracture walking boot to hold it still.
The amount of displacement matters. So, when you pull it apart, obviously the closer it is together, the more likely it is to heal. There are lots of different criteria we use to determine what’s really bad with displacement and what’s acceptable with displacement. In general, less than two millimeters of displacement is acceptable. So, two millimeters is not very much. it’s real close together, it’s only about two millimeters apart and generally that is okay. There are certain places and certain bones where more displacement may be tolerated. The shaft of the fifth metatarsal can be further apart and still heal and connect and turn into solid bone again than some other areas of your foot but in general, it’s two millimeters.
Displaced just means a part, angulated with displacement is worse, and more than two millimeters is generally speaking bad, but it depends on the position. So, listen to what your doctor says.
If you want to learn more about stress fractures, how this happens, how a stress fracture goes from just being in an inflamed bone to a cracked bone to being one that gets moved out of place or out of position, you can learn more about that in the metatarsal stress fracture class. I also share all the exact strategies I use with injured runners who want to get back to running quickly. and it’s the same stuff I teach to doctors at medical conferences. You can get it for free at www.docontherun.com/stressfracturemasterclass. So, come sign up and I’ll see you in the training.
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