From the Guidelines
Surgery is the usual treatment for 5th metatarsal avulsion fracture, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. The diagnosis of a 5th metatarsal avulsion fracture is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
Key Considerations
- The treatment approach depends on the size and displacement of the fracture fragments.
- For small, nonarticular, or minimally displaced fractures, simple immobilization may be sufficient.
- The goal of treatment is to promote healing, reduce pain and swelling, and restore function.
Treatment Options
- Conservative management with protected weight-bearing for 6-8 weeks may be considered for non-displaced or minimally displaced fractures.
- Surgery may be necessary for significantly displaced fractures or those with substantial intra-articular involvement.
- Pain management with acetaminophen or NSAIDs, and physical therapy to improve ankle range of motion, strengthening, and proprioception, are important components of treatment.
Expected Outcomes
- Most avulsion fractures heal well with conservative treatment or surgery, with full recovery typically taking 8-12 weeks.
- Patients should be advised to gradually return to sports and high-impact activities only after demonstrating full pain-free range of motion and strength.
From the Research
Treatment Options for 5th Metatarsal Avulsion Fracture
- Surgical management: Studies have shown that surgical management of 5th metatarsal avulsion fractures can help eliminate the risk of nonunion and ensure a timely return to preinjury activity 2. Surgical management is recommended for fractures displaced >2 mm.
- Conservative management: Conservative management, including immobilization with a below-knee cast or pneumatic walking boot, can also be effective in treating 5th metatarsal avulsion fractures 2, 3. However, conservative management may result in a higher incidence of asymptomatic nonunion.
- Symptomatic treatment: Symptomatic treatment, such as the use of a double elasticated bandage, has been shown to be non-inferior to immobilization in terms of patient-reported outcome measures 3.
Fracture Classification and Treatment
- Zone I fractures: Early functional therapy is recommended for zone I fractures, as it can result in a faster return to full function and similar outcomes compared to immobilization or surgery 4.
- Zone II fractures: Similar to zone I fractures, early functional therapy is recommended for zone II fractures, as it can result in similar outcomes compared to immobilization 4.
- Zone III fractures: Surgical treatment is recommended for zone III fractures, as it can result in statistically significant improvement in outcomes compared to immobilization 4.
General Principles of Treatment
- The choice of treatment for 5th metatarsal avulsion fractures depends on various factors, including the location and displacement of the fracture, as well as the patient's overall health and activity level 2, 5.
- A thorough review of the relevant literature and consideration of the individual patient's needs are necessary to determine the most effective treatment approach for 5th metatarsal avulsion fractures 5.