From the Guidelines
The optimal treatment for a fracture of the 2nd and 3rd metatarsal bones is typically conservative management with immobilization, as surgery is usually reserved for cases with significant displacement or other complicating factors 1. When managing these fractures, it's essential to consider the size and displacement of the fracture fragments.
- For small, nonarticular, or minimally displaced fractures, simple immobilization is often sufficient 1.
- Immobilization can be achieved using a walking boot, stiff-soled shoe, or cast for 4-6 weeks, depending on the severity and displacement of the fracture.
- Weight-bearing status should be determined based on fracture characteristics, with non-displaced fractures often allowing protected weight-bearing in a walking boot.
- Pain management is crucial and can be achieved with acetaminophen or NSAIDs like ibuprofen for the first 1-2 weeks.
- Surgical intervention may be necessary for significantly displaced fractures, multiple fractures, or when alignment cannot be maintained with conservative measures.
- Physical therapy focusing on range of motion, strengthening, and gait training should begin after adequate healing, usually around 6 weeks post-injury. The goal of treatment is to promote bone healing, minimize morbidity, and optimize quality of life, which can be achieved through careful consideration of the fracture characteristics and individual patient needs 1.
From the Research
Treatment Options for Metatarsal Fractures
The optimal treatment for a fracture of the 2nd and 3rd metatarsal bones depends on the severity and displacement of the fracture.
- Non-operative treatment is often used for non-displaced or minimally displaced fractures, with the goal of maintaining the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint 2.
- For displaced fractures, surgical intervention may be necessary to preserve normal gait biomechanics 2.
- The treatment of central metatarsal fractures, which include fractures of the 2nd and 3rd metatarsals, typically involves conservative treatment for fractures with less than 10° of angulation and 3-4 mm of translation in any plane, while operative treatment is reserved for more severe fractures 3.
Surgical Treatment
- Intramedullary fixation with K-wires is a common surgical treatment for simple fractures, while spiral fractures may require interfragmentary screws or an osteosynthesis with a dorsal plate 3.
- The choice of surgical treatment depends on the pattern of the fracture and the patient's condition.
Conservative Treatment
- Conservative treatment, such as immobilization in a cast or splint, can be effective for non-displaced or minimally displaced fractures 4, 5, 6.
- The use of a short leg walking cast or boot for 4-6 weeks is a common conservative treatment approach for metatarsal shaft fractures 6.
- The Göttinger Anklesplint bandage has been shown to be a cost-effective and effective treatment option for metatarsal V basis fractures, with good functional outcomes 5.