Background: The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. Methods: Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. Results: The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. Conclusion: With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. Level of Evidence: Level IV, case series.

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: The treatment of 5th metatarsal stress fractures of the can be challenging and at times can result in significant disability. Intramedullary screw fixation has become a popular surgical method for management. However, many recent reports have described failures after screw fixation in athletes. The aim of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and complications of elite athletes with proximal fifth metatarsal fracture treated with plantar plating. Methods: Thirty-eight patients with fifth metatarsal stress fractures treated using the plantar plating technique in four hospitals from 2013 to 2018 were evaluated retrospectively. All of the patients were elite athletes. Demographic data, radiographic evaluation, and the time until union and return to unrestricted sporting competition were collected and analyzed. Results: A total of 38 patients underwent the plantar plating for 5th metatarsal stress fracture with a mean follow-up of 23 months (range, 12-49 months). The mean time to radiologic union as determined by CT was 9.3 weeks (range, 8-16 weeks). However, during follow-up, there were 4 refractures but no union problems. One patient experienced temporary sensory disturbance that resolved within 3 months. There was one patient with temporary wound complication, two cases with hardware prominence. All but one patients were able to return to their previous levels of sporting activity at 21 ± 4 (range, 18 to 40) weeks. Conclusion: With minimum 1-year follow-up, the described plantar plating technique is a good alternative method for the surgical treatment of fifth metatarsal stress fractures with less complications.