Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

Abstract

Purpose To compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures. Methods A literature search was performed to identify studies published from the earliest record to January 2019 using EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method. Results Thirty-two articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies. 627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment. Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases. For Jones' (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively. Only ten proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks. Conclusion Acute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. In contradistinction, acute zone 2 fractures demonstrate higher union rates and faster time to union when treated surgically. The outcomes of acute zone 3 fractures are rarely reported in the literature, so treatment recommendations remain unclear. Further research of proximal fifth metatarsal fractures is warranted to provide more definitive conclusions, but current findings can aid surgeons during the shared clinical decision making process. Level of evidence IV.

Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management

“…Nonoperative management is viable for most patients, but surgical fixation is recommended for athletes due to improved union rates, decreased complication rates, and shorter return to play times [7,12,42]. Zone 2 fractures in elite athletes should be treated with surgery over nonoperative management for 3 reasons: higher union rates (95% vs 70 to 90%, respectively) [34,57], quicker time to union (7 weeks vs 10 to 12 weeks, respectively) [10], and lower refracture risk (<5% vs 10 to 13%, respectively) [6,15,26]. Different operative techniques have been described in the literature, such as intramedullary screw, tension band wiring, differential pitch screw, and percutaneous bi-cortical screw [8,58].…”

Fractures of the Base of the Fifth Metatarsal Bone

“…Nonoperative treatment for nondisplaced true zone-2 fractures (i.e., an acute transverse or short oblique fracture exiting through the fourth-fifth intermetatarsal joint) is generally indicated in the nonathletic population 27,49,56,86,89,94,95,99,128 . There is no evidence that nonoperative treatment substantially increases the risk of refracture 49,53,99,129 . However, the time to heal and return to full activities can be decreased with operative treatment, which is of particular interest for athletes and young high-demand patients 47,64,130 .…”

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

“…The literature suggests that there is a significant variation in the effectiveness of conservative treatment within different fracture subtypes. Nondisplaced Zone 1 fractures at the fifth metatarsal base are often treated using protected weight-bearing methods, such as leg casts, that offer low nonunion rates of between 0.5% and 2.1%[ 47 ]. In other studies, it has been illustrated that nonoperative procedures for acute Zone 2 and 3 fractures result in longer recuperation times and a higher risk of refracturing.…”