Non-Surgical Treatment of Displaced Fifth Metatarsal Fractures
For displaced fifth metatarsal fractures, surgical treatment is indicated when displacement exceeds 2-3mm, angulation is greater than 10 degrees, or when more than 30% of the cubometatarsal joint is involved. 1
Classification and Assessment
Fifth metatarsal fractures can be categorized by location:
- Tuberosity avulsion fractures (most common)
- Jones fractures (at metaphyseal-diaphyseal junction)
- Shaft fractures
- Distal/neck fractures
Displacement Criteria for Non-Surgical Management
- Displacement less than 2mm for tuberosity fractures 1
- Displacement less than 3-4mm for shaft fractures 1
- Angulation less than 10 degrees 1
- Less than 30% involvement of the cubometatarsal joint 1, 2
Non-Surgical Treatment Protocol
Immobilization Options
- Rigid immobilization is preferred for displaced fractures that still meet non-surgical criteria 3
- Cast shoe with protected weight bearing for 4-6 weeks for minimally displaced fractures 2
- For non-displaced fractures, functional treatment with early weight bearing and no immobilization has shown promising results with earlier healing and fewer adverse effects 4
Weight Bearing Status
- Early weight bearing is recommended to prevent stiffness and promote healing 4
- Protected weight bearing in a cast shoe for 4-6 weeks for minimally displaced fractures 2
- Some studies support immediate weight bearing with appropriate support 5
Monitoring and Follow-up
- Radiographic evaluation should be performed at 3 weeks and at cessation of immobilization 3
- Average time to bony union is approximately 3.7 months 5
Special Considerations for Jones Fractures
Jones fractures (transverse fractures at the metaphyseal-diaphyseal junction) require special attention due to their higher risk of delayed union or non-union:
- Torg Classification guides treatment:
- Type I (acute fracture): Non-operative treatment
- Type II (delayed union): Treatment depends on patient activity level
- Type III (non-union with sclerosis): Surgical treatment recommended 1
Complications to Monitor
- Delayed union or non-union (particularly with Jones fractures)
- Malunion leading to pain and disability 2
- Post-traumatic deformities that may require later correction
Treatment Outcomes
Non-operative treatment has shown high success rates:
- 98.5% union rate with appropriate patient selection 5
- 100% satisfaction rate in patients where time to return to full activities is not critical 5
Pitfalls and Caveats
- Failure to recognize displacement exceeding surgical thresholds can lead to malunion
- Inadequate follow-up may miss progressive displacement during healing
- Jones fractures have higher complication rates and may require more aggressive treatment
- Patient activity level should be considered when deciding between surgical and non-surgical management
- Non-operative treatment may be appropriate even for some displaced fractures in less active patients or those who can tolerate longer recovery times 5