From the Guidelines
The treatment for a nondisplaced metatarsal fracture in a 6-year-old typically involves simple immobilization, as surgery is usually reserved for more complex cases with significant displacement or articular involvement 1. When managing a nondisplaced metatarsal fracture in a child, it's essential to consider the child's age and the potential for bone remodeling.
- The child's fracture can be managed with a walking boot or cast for 3-4 weeks, allowing for weight-bearing as tolerated.
- Pain management can include acetaminophen (10-15 mg/kg every 4-6 hours as needed) or ibuprofen (5-10 mg/kg every 6-8 hours as needed) for the first few days.
- Activity should be restricted from sports and high-impact activities until healing is complete, typically 4-6 weeks.
- Follow-up X-rays are recommended at 3-4 weeks to confirm proper healing, as children's bones heal more quickly than adults' and have greater remodeling potential, allowing for excellent outcomes with conservative treatment 1. Key considerations in the treatment of nondisplaced metatarsal fractures in children include:
- The potential for bone remodeling and the child's overall health
- The need for immobilization to promote proper healing
- The importance of follow-up care to monitor the child's progress and address any potential complications
- The child's ability to bear weight and participate in normal activities within 6-8 weeks, with most children experiencing excellent outcomes with conservative treatment.
From the Research
Treatment for Nondisplaced Metatarsal Fracture in a 6-year-old
- Generally, nondisplaced metatarsal fractures can be treated nonoperatively 2.
- Fracture angulation of more than 10 degrees or fracture displacement of more than 3-4 mm are a valid indication for open or closed reduction 2.
- For nondisplaced tuberosity avulsion fractures, non-operative treatment is recommended 3.
- Non or minimally displaced shaft fractures can be treated non-operatively 3.
- The treatment goals of metatarsal fractures are to maintain the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint, and most of these injuries can be treated nonoperatively, but displaced fractures require surgical intervention to preserve normal gait biomechanics 4.
Specific Considerations for Children
- Most fractures of the fifth metatarsal in the pediatric population do well clinically after a course of walking cast, unless the fracture is an intra-articular displaced fracture type or the fracture occurs in the proximal diaphyseal area 5.
- Fixation of Jones fractures in active adolescents should be considered to allow faster return to regular activities and prevent refracture 5.
- Non-weight bearing casts are recommended for all angulated or displaced intra-articular injuries to avoid delays in healing and angulation 5.