From the Research
The recommended treatment for an avulsion fracture at the base of the 5th metatarsal is surgical management if the fracture is displaced >2mm, as it helps to eliminate the risk of nonunion and ensures a timely return to preinjury activity, as supported by the study 1.
Treatment Approach
The treatment approach for an avulsion fracture at the base of the 5th metatarsal depends on the displacement of the fracture.
- For fractures with minimal or no displacement, conservative management may be sufficient, including rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce swelling and pain.
- Weight-bearing as tolerated with a supportive shoe, walking boot, or hard-soled shoe is generally permitted.
- Pain management can be achieved with over-the-counter medications like acetaminophen or NSAIDs such as ibuprofen for 5-7 days.
Surgical Management
However, for fractures displaced >2mm, surgical management is recommended, as it provides anatomical stable fixation and early mobilization, leading to better outcomes and reduced risk of nonunion, as shown in the study 1.
- Surgical management involves closed reduction and fixation with a percutaneous screw, which allows for early weight-bearing and return to activity.
- The American Orthopaedic Foot and Ankle Society score was significantly better in the operative group at 6 months after treatment, indicating improved functional outcomes with surgical management, as reported in the study 2.
Conservative Management
For fractures with minimal or no displacement, conservative management may be sufficient, and the use of a walking boot or cast may be considered, as supported by the study 3.
- The study 4 found that symptomatic treatment was non-inferior to immobilization in a cast, and patients in the symptomatic treatment group had improved pain and function scores at 4 weeks and 6 months.
Conclusion Not Applicable - Outcome Based Answer Only
The treatment approach for an avulsion fracture at the base of the 5th metatarsal should prioritize surgical management for displaced fractures >2mm, as it provides the best outcomes in terms of morbidity, mortality, and quality of life, as supported by the study 1.