From the Guidelines
The treatment for a fifth metatarsal fracture typically involves surgery as the usual treatment, however, simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
Initial Management
- The diagnosis is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
- Pain control is crucial in the initial management of fifth metatarsal fracture.
- Immobilization is achieved through the use of a walking boot or cast, with weight-bearing status determined on a case-by-case basis.
Surgical Intervention
- For fractures that are displaced or unstable, surgical intervention may be necessary, involving open reduction and internal fixation with a screw or plate 1.
- The goal of surgical intervention is to achieve anatomical reduction and stable fixation, allowing for early mobilization and rehabilitation.
Post-Operative Care
- A post-operative course of prophylactic antibiotics may be necessary to prevent infection.
- The choice of antibiotic and duration of treatment should be determined on a case-by-case basis, taking into account the patient's individual risk factors and medical history.
From the Research
Treatment Options for Fifth Metatarsal Fracture
- The treatment for a fifth metatarsal fracture can vary depending on the severity and location of the fracture, as well as the patient's overall health and activity level 2, 3, 4.
- For grossly displaced fractures, open reduction and internal fixation (ORIF) is often recommended to restore the anatomical structure of the forefoot and promote healing 2.
- ORIF can be performed using various techniques, including plate fixation, screw fixation, and tension band wiring 2, 3, 4.
- For less severe fractures, nonoperative treatment may be sufficient, involving rest, elevation, and partial weight-bearing in a foot orthosis or cast shoe for 6 weeks 2, 3.
- In some cases, percutaneous screw fixation may be used to treat zone 2 intra-articular Jones fractures with minimal to moderate displacement 4.
Surgical Techniques
- Open reduction and internal fixation (ORIF) is a common surgical technique used to treat fifth metatarsal fractures, involving the use of plates, screws, or wires to stabilize the fracture 2, 3, 4.
- Percutaneous screw fixation is a minimally invasive technique that can be used to treat zone 2 intra-articular Jones fractures with minimal to moderate displacement 4.
- Suture anchor fixation is another technique that can be used to treat fifth metatarsal tuberosity avulsion fractures 5.
Postoperative Care
- After surgical treatment, patients are typically advised to rest and elevate the injured leg, and to use ice to reduce swelling and pain 2, 4.
- Patients are also advised to avoid weight-bearing for a period of time, typically 2-6 weeks, and to use a postoperative boot or cast shoe to protect the foot and promote healing 2, 4.
- Physical therapy and rehabilitation exercises can be started after the initial healing period to promote strength and mobility in the foot and ankle 4.
Complications and Risks
- Nonunion and delayed union are potential complications of fifth metatarsal fractures, particularly if nonoperative treatment is used 3, 4.
- Surgical treatment can also carry risks, such as infection, nerve damage, and hardware failure 2, 4.
- Patients with certain medical conditions, such as diabetes or vascular disease, may be at higher risk for complications and may require alternative treatment options 4.