From the Guidelines
Surgery is the usual treatment for a 3rd metatarsal fracture, although simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. The diagnosis of a 3rd metatarsal fracture is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
Treatment Options
- For non-displaced fractures, conservative management is usually recommended, including rest, ice, compression, and elevation (RICE protocol)
- Weight-bearing restrictions are important, often requiring a walking boot, stiff-soled shoe, or cast for 4-6 weeks
- Patients should use crutches initially to avoid putting weight on the injured foot
- Pain management typically involves over-the-counter medications like acetaminophen or NSAIDs such as ibuprofen for 1-2 weeks as needed
Surgical Intervention
- For displaced fractures or those involving the joint surface, surgical intervention may be necessary, involving internal fixation with screws, plates, or pins to realign the bone
- Physical therapy is often recommended during the recovery phase to restore strength and range of motion, typically starting around 4-6 weeks after injury
Recovery and Follow-up
- Complete healing usually takes 6-12 weeks, though return to high-impact activities may require additional time
- Regular follow-up with X-rays is essential to monitor proper bone healing, as noted in the american college of foot and ankle surgeons diagnosis and treatment guidelines 1
From the Research
Treatment Options for 3rd Metatarsal Fracture
- The treatment for 3rd metatarsal fracture can vary depending on the severity and type of fracture.
- According to 2, open reduction and internal fixation with bioabsorbable pins can be an effective treatment option for isolated chronic osteochondral fractures of the third metatarsal head.
- For displaced central metatarsal fractures, open reduction and internal fixation may be necessary to achieve and maintain reduction, as stated in 3.
- A systematic review of the literature on operative treatment of acute shaft and neck lesser metatarsals fractures found that K-wire intramedullary nailing is associated with better outcomes compared to open reduction and internal fixation, as it permits faster weight bearing and quicker rehabilitation 4.
- However, it's worth noting that the best method for treatment of this type of fracture is unclear, and more research is needed to determine the most effective treatment options.
Surgical vs. Non-Surgical Treatment
- Surgical treatment options, such as open reduction and internal fixation, may be necessary for displaced or complex fractures.
- Non-surgical treatment options, such as immobilization and weight-bearing restrictions, may be suitable for non-displaced or minimally displaced fractures.
- A study on conservative management of Jones fractures with immediate weight-bearing in a walking boot found that this approach can demonstrate healing, although controversy still exists as to the best treatment methodology for acute Jones fractures 5.
Considerations for Treatment
- The mechanism of injury, such as shear force, can affect the treatment approach.
- The patient's age, activity level, and overall health can also influence the treatment decision.
- Further research is needed to determine the most effective treatment options for 3rd metatarsal fractures, as the current evidence is limited and inconclusive.