From the Guidelines
The best way to splint a 5th metatarsal fracture is through simple immobilization, which is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as stated by the American College of Foot and Ankle Surgeons 1. When managing a 5th metatarsal fracture, it's crucial to prioritize immobilization to prevent further displacement and promote healing.
- The initial step involves applying a posterior splint with the ankle at 90 degrees and the foot slightly inverted to reduce tension on the peroneus brevis tendon.
- Padding the leg and foot with cotton padding is essential to prevent pressure sores and ensure comfort.
- A U-shaped plaster or fiberglass splint extending from below the knee to the toes, wrapping around the lateral side of the foot, should be applied to provide adequate support and stabilization.
- The splint should be secured with an elastic bandage, ensuring it's snug but not tight enough to compromise circulation.
- Patients should be advised to be non-weight bearing and use crutches until evaluated by an orthopedic specialist, typically within 5-7 days.
- Elevating the foot above heart level when possible and applying ice for 20 minutes every 2-3 hours for the first 48-72 hours can help reduce swelling.
- Appropriate pain medication, such as ibuprofen 400-600mg every 6 hours or acetaminophen 650-1000mg every 6 hours, should be provided to manage pain and discomfort. This approach to splinting a 5th metatarsal fracture prioritizes immobilization, reduces the risk of complications, and promotes optimal healing, as supported by the American College of Foot and Ankle Surgeons 1.
From the Research
Treatment Options for 5th Metatarsal Fracture
- The treatment of a 5th metatarsal fracture can vary depending on the type and location of the fracture, with options including immobilization, functional treatment, and osteosynthesis 2.
- A study published in 1997 found that early functional treatment using an orthopedic boot allowed for full weightbearing after approximately 9 days and resulted in an average time of sick-leave of 19 days, with no long-term complications and a high patient satisfaction rate of 92% 2.
- Another study published in 2016 compared symptomatic treatment with cast immobilization for avulsion fractures of the base of the fifth metatarsal and found that symptomatic treatment was not inferior to cast immobilization in terms of patient-reported outcome measures 3.
Comparison of Treatment Methods
- A systematic review and meta-analysis published in 2018 compared the outcomes of cast and removable support for fracture of the fifth metatarsal bone and found that treatment with a splint (boot or bandage) resulted in better foot function scale scores and a lower nonunion rate compared to short leg cast treatment 4.
- The same study found that the risk of nonunion was insignificantly greater with short leg cast treatment compared to splint treatment, with a risk ratio of 1.57 (95% CI 0.29 to 8.49) 4.
Current Treatment Recommendations
- A review article published in 2016 provided a thorough review of fifth metatarsal fractures and described the management of these fractures, including nonoperative and operative management options according to anatomical region 5.
- The article highlighted the importance of considering the classification and location of the fracture when determining the best treatment approach 5.