What is the treatment for an acute non-displaced transverse intra-articular fracture at the base of the left fifth metatarsal in a 64-year-old female?

Treatment of Acute Non-Displaced Transverse Intra-articular Fracture at the Base of the Fifth Metatarsal

For an acute non-displaced transverse intra-articular fracture at the base of the left fifth metatarsal in a 64-year-old female, conservative treatment with protected weight bearing in a cast shoe for 4-6 weeks is the recommended approach. 1

Initial Assessment and Management

• Radiographic Evaluation:

  • Confirm the non-displaced nature of the fracture
  • Ensure intra-articular involvement is minimal
  • Check for any signs of instability

• Conservative Treatment Approach:

  • Protected weight bearing in a cast shoe for 4-6 weeks 1
  • Rigid immobilization (cast) is preferred over removable splints for optimal healing 2
  • Follow-up radiographs recommended at 3 weeks and at cessation of immobilization 2

Rationale for Conservative Management

This approach is supported by evidence showing that:

1. Non-displaced fractures of the fifth metatarsal can be effectively treated conservatively 1
2. Intra-articular fractures with minimal displacement can be immobilized in a plaster cast without reduction 3
3. Functional treatment provides earlier healing and fewer adverse effects than conventional therapies for non-displaced fractures 4

Special Considerations for Elderly Patients

For this 64-year-old female patient:

• Evaluate for osteoporosis risk as part of the treatment plan 5
• Consider calcium and vitamin D supplementation during the healing process 5
• Assess fall risk factors to prevent subsequent fractures 5

When to Consider Surgical Intervention

Surgery would only be indicated if:

• Displacement occurs during treatment (>2mm)
• Articular involvement exceeds 30% of the joint surface 1
• There is evidence of instability

Follow-up Protocol

1. Initial follow-up with radiographs at 3 weeks to ensure maintained alignment
2. Final radiographic assessment at 4-6 weeks when immobilization is discontinued
3. Evaluate for:
   • Proper bone healing
   • Joint congruity
   • Development of post-traumatic arthritis

Common Pitfalls to Avoid

• Inadequate immobilization: Can lead to displacement and poor healing
• Premature weight bearing: May cause displacement of initially non-displaced fractures
• Missing associated injuries: Always check for other foot/ankle injuries
• Overlooking osteoporosis: In a 64-year-old female, consider bone health assessment as part of treatment 5

Rehabilitation

After immobilization period:

• Progressive weight bearing as tolerated
• Range of motion exercises
• Strengthening exercises
• Balance training to prevent future falls 5

This treatment approach prioritizes bone healing while minimizing complications and maintaining function, which is especially important in elderly patients to preserve mobility and quality of life.