From the Guidelines
The most effective approach to reduce a left fifth metatarsal fracture is to prioritize conservative management for non-displaced or minimally displaced fractures, while considering surgical intervention for displaced fractures, particularly those in the proximal zone (Jones fractures) or showing delayed healing, as evidenced by the most recent guidelines 1.
Key Considerations
- The location, displacement, and patient factors play a crucial role in determining the treatment approach for a left fifth metatarsal fracture.
- Conservative management with a walking boot or stiff-soled shoe for 6-8 weeks, weight-bearing as tolerated, ice application, elevation, and over-the-counter pain medications is recommended for most non-displaced or minimally displaced fractures.
- Regular follow-up with orthopedic evaluation and X-rays at 2,4, and 6-8 weeks is essential to ensure proper healing.
- Surgical intervention with internal fixation may be necessary for displaced fractures, those in the proximal zone (Jones fractures), or fractures showing delayed healing, as highlighted in the guidelines 1.
High-Risk Fractures
- The fifth metatarsal base is considered a high-risk area for stress fractures due to its tendency for nonunion or delayed union, as noted in the study 1.
- Patients with osteoporosis, those on bisphosphonate therapy, and athletes are at high risk for fracture completion and may require more aggressive management.
Treatment Approach
- The treatment approach should prioritize bone healing while maintaining function, as the 5th metatarsal bears significant weight during walking and is subject to forces that can complicate healing.
- Physical therapy is often beneficial after the immobilization period to restore strength and range of motion.
- The most recent guidelines 1 emphasize the importance of identifying and modifying risk factors to prevent progression to complete fracture, particularly in high-risk patients.
From the Research
Treatment Options for Left Fifth Metatarsal Fracture
- The treatment for a left fifth metatarsal fracture can vary depending on the type and severity of the fracture, with options including cast immobilization, symptomatic treatment, and surgical intervention 2, 3, 4, 5.
- For traumatic metatarsal injuries, treatment remains relatively straightforward, whereas traditional stress fractures typically heal with decreased activity 2.
- Proximal fifth metatarsal fractures (Jones fractures) frequently require surgical intervention in patients who want to avoid non-weight-bearing cast immobilization 2.
- Early functional treatment of a fracture of the base of the fifth metatarsal bone with an orthopedic boot has been shown to be a reliable and cost-effective treatment, allowing full weight-bearing after approximately 9 days and resulting in an average time of sick-leave of 19 days 3.
- Symptomatic treatment has been found to be non-inferior to immobilization in terms of patient-reported outcome measures for avulsion fractures of the base of the fifth metatarsal 4.
Surgical Management
- Surgical management of fifth metatarsal diaphyseal fractures has been shown to result in good outcomes with minimal postoperative complications, with a mean healing time of 7.73 weeks and an overall complication rate of 6.25% 5.
- Surgical intervention is advocated even for minimally displaced diaphyseal fractures to maintain even weight-bearing across the metatarsal parabola 5.
Conservative Management
- Conservative treatment with weight-bearing as pain allows and the use of an elasticated support or removable boot has been shown to be safe and effective, with no added clinical value for routine outpatient follow-up 6.
- Patients can be safely discharged and allowed to bear weight at the time of initial presentation if they are provided with appropriate information and ready access to experienced fracture clinic staff 6.