Fifth metatarsal fractures: an update on management, complications, and outcomes

Abstract

Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

Fifth Distal Phalanx Avulsion Fracture in a High-Level Marathon Runner

“…Non-operative management is often the preferred initial treatment for avulsion and non-displaced diaphyseal fractures. This may include immobilization with a short leg cast, walking boot, or rigid shoe, along with limited weight-bearing for a period of four to six weeks [ 17 ]. Following this period, progressive weight-bearing and physical therapy can be initiated to restore function and strength.…”

“…Nonoperative treatment has demonstrated favorable outcomes in patients with stable fractures and minimal displacement [ 18 ]. Surgical intervention is generally reserved for fractures with significant displacement, comminution, or those at high risk of nonunion due to the limited blood supply at the metaphyseal-diaphyseal junction and may necessitate surgical fixation with intramedullary screw fixation or tension band wiring [ 17 ]. Displaced diaphyseal fractures may also require open reduction and internal fixation with plates and screws for adequate stability [ 19 ].…”

“…Nondisplaced fractures inherently maintain alignment and stability, allowing efficient bone healing without the need for surgical intervention [ 21 ]. Furthermore, although the distal metatarsal phalanx is not the main weight-bearing joint, bracing, immobilization, and rest for four weeks may provide adequate support and protection for the healing fracture [ 17 ]. After the initial immobilization and limited weight-bearing phases, a structured rehabilitation program should be implemented that focuses on progressive weight-bearing, range-of-motion exercises, and strengthening [ 16 ].…”

“…Our conservative approach, including the use of rehabilitative exercises, IASTM, ultrasound, laser therapy, and manual therapy to the proximal joints, also plays a pivotal role in the nonoperative management of fifth metatarsal fractures, ensuring a successful return to activities and minimizing the risk of reinjury. Gradual reintroduction of weight-bearing activities enhances the healing process while mitigating the risk of delayed union or nonunion [ 17 ]. This conservative treatment modality minimizes the risk of complications associated with surgery such as infection, nerve or vascular injury, and hardware-related issues [ 22 ].…”

Fracture of the Fifth METATARSAL.BIBLIOGRAPHIC Review

“…It is recommended to present patients with several treatment alternatives, the patient should be part of the decision of the procedure to be performed since it has a direct impact on the time for recovery and return to activities (10).…”