Intra-articular base of 5th metatarsal fractures (Zone 2) – Should we be operating on more of these fractures?

Zone 2 5th Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively

“…Operative management of Zone 2 fractures did not lead to a higher rate of radiographic union or decrease in the time to radiographic union by or return to baseline function, which refutes the claims of previous studies that advocate for surgical intervention of these fractures. 2,5,9,11,12,[17][18][19][20] Chuckpaiwong et al 17 retrospectively reviewed a series of 32 Zone 2 fractures in athletes who underwent operative fixation with intramedullary screws and found a quicker return to sport by 15 weeks compared with patients treated nonoperatively. However, the unique population of competitive athletes limits the generalizability of this study to the population at large.…”

“…Early functional weight-bearing status and return to activity seem to have more of an impact and lead to excellent and quicker clinical outcomes. 5,7,20,22,23 A study by Vertullo et al 24 revealed that the ability of operative fixation to sufficiently resist torsional strain at the fracture site and create a stable load dispersion throughout the foot may be a reason why operative patients seem to have quicker clinical improvement, return to full weight-bearing, and return to sport. Factors that contribute to adverse outcomes include female sex, diabetes mellitus, and obesity.…”

“…Operative management of Zone 2 fractures did not lead to a higher rate of radiographic union or decrease in the time to radiographic union by or return to baseline function, which refutes the claims of previous studies that advocate for surgical intervention of these fractures. 2,5,9,11,12,17–20…”