Fifth metatarsal fractures and current treatment

Core Tip

Core tip: Nondisplaced fifth metatarsal fractures can be treated nonoperatively depending on fracture location and patient factors. When nonoperative management is utilized improved early functional scores are associated with less rigid immobilization and a shorter period of nonweightbearing. Neck and shaft fractures with greater than ten degrees plantar angulation or three millimeters of displacement in any plane where closed reduction is insufficient require operative management. Operative intervention is recommended for base of the fifth metatarsal avulsion fractures (zone one) with more than three millimeters of displacement. Acute and delayed union zone two fractures may be managed nonoperatively but operative management with an intramedullary screw should be considered in athletes. Zone three (diaphyseal stress fractures) fractures that are Torg type I and type II should be managed with intramedullary screw fixation in the athlete. In the non-athlete these fractures may be managed nonoperatively however prolonged immobilization is often required and a nonunion may still result. Symptomatic nonunions of zone two and zone three fractures should be managed operatively.