What is the treatment for a displaced 5th metatarsal fracture?

Treatment for Displaced 5th Metatarsal Fracture

Displaced 5th metatarsal fractures typically require surgical intervention with internal fixation to restore anatomical alignment, prevent complications, and optimize functional outcomes.

Surgical Management Decision Algorithm

The treatment approach depends on the specific characteristics of the fracture:

Location-Based Treatment

1. Tuberosity Avulsion Fractures (Base of 5th metatarsal)

   • If displacement >2mm or >30% of cubometatarsal joint involvement: Surgical treatment with open reduction and internal fixation using tension-band wiring or screw fixation 1
   • If minimally displaced (<2mm): Conservative management with protected weight bearing

2. Shaft Fractures (Diaphyseal)

   • If displacement >3-4mm or angulation >10 degrees: Surgical fixation with percutaneous K-wires, plate or screw fixation 1
   • If minimally displaced: Non-operative treatment with protected weight bearing

3. Jones Fractures (Metaphyseal-diaphyseal junction)

   • Treatment depends on Torg classification and patient activity level:
     • Type I (acute fracture): Non-operative treatment
     • Type II (delayed union): Surgical fixation for active patients
     • Type III (non-union with sclerosis): Surgical fixation recommended 1

Surgical Techniques

• Percutaneous pinning: Suitable for most displaced fractures of the lesser metatarsals 2
• Open reduction and plate fixation: Required for fractures with joint involvement and multiple fragments 2
• Tension-band wiring or screw fixation: For avulsion fractures with significant displacement 1

Post-Surgical Management

• Appropriate pain management after closed reduction 3
• Early mobilization and rehabilitation 3
• Antibiotic prophylaxis to prevent infection 3
• Regular wound assessment and care 3

Non-Operative Management (for reference)

For non-displaced or minimally displaced fractures:

• Protected weight bearing in a cast shoe or removable boot for 4-6 weeks 2
• Functional treatment with early weight bearing may provide faster healing for non-displaced fractures 4, 5

Follow-Up Considerations

• Routine follow-up may not be necessary for all 5th metatarsal fractures if patients are provided with appropriate information and access to care if needed 6
• For surgically managed fractures, follow-up should assess:
  • Wound healing
  • Radiographic alignment
  • Return to function
  • Complications (non-union, malunion)

Potential Complications to Monitor

• Non-union (particularly with Jones fractures)
• Malunion leading to pain and disability
• Hardware-related issues
• Infection
• Persistent pain

Special Considerations

• Jones fractures have a higher risk of delayed union or non-union due to the watershed blood supply in this region
• Patient activity level should influence treatment decisions, with more aggressive surgical management for active individuals
• Malunited fractures may require corrective osteotomy if symptomatic 2

Remember that appropriate treatment of displaced 5th metatarsal fractures requires careful assessment of fracture characteristics and patient factors to optimize functional outcomes and prevent long-term disability.