Surgical Management of Fifth Metatarsal Diaphyseal Fractures: A Retrospective Outcomes Study


      Fifth metatarsal diaphyseal fractures are a common injury treated by foot and ankle surgeons. The limited data on this specific fracture type has promoted nonoperative treatment with immobilization. The primary objective of the present study was to record the radiographic healing time of fifth metatarsal diaphyseal fractures after surgical intervention and present the specific fracture characteristics. The medical records of a series of 64 patients with surgically managed fifth metatarsal diaphyseal fractures were retrospectively reviewed. The data collected consisted of radiographic healing times, fracture characteristics, and patient demographics. The mean average age at injury was 49.23 ± 15.35 years with greatest incidence in females at 73.44%. The mean healing time was 7.73 ± 4.74 weeks, with an overall complication rate of 6.25%. The fractures were classified into 2 specific categories according to the anatomic location. Type I fractures occurred in a significantly older population, were significantly longer in length, and healed faster. The mean displacement and angulation at injury was 3.20 ± 1.22 mm, and 5.89° ± 4.60°, respectively, for all fractures. Of the 64 patients, 1 (1.56%) experienced nonunion, 2 (3.13%) delayed unions, and no malunions. One patient (1.56%) underwent repeat operation for hardware removal. One case (1.56%) of superficial postoperative infection developed and was treated with oral antibiotics. We observed good surgical outcomes with minimal postoperative complications. We also identified 2 specific entities of fifth metatarsal diaphyseal fractures. On the basis of our results, we advocate surgical intervention even for minimally displaced diaphyseal fractures to maintain even weightbearing across the metatarsal parabola.

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        • Bigsby E.
        • Halliday R.
        • Middleton R.G.
        • Case R.
        • Harries W.
        Functional outcome of fifth metatarsal fractures.
        Injury. 2014; 45: 2009-2012
        • Cakir H.
        • Van Vliet-Koppert S.T.
        • Van Lieshout E.M.
        • De Vries M.R.
        • Van Der Elst M.
        • Schepers T.
        Demographics and outcome of metatarsal fractures.
        Arch Orthop Trauma Surg. 2011; 131: 241-245
        • Petrisor B.A.
        • Ekrol I.
        • Court-Brown C.
        The epidemiology of metatarsal fractures.
        Foot Ankle Int. 2006; 27: 172-174
        • O'Shea M.K.
        • Spak W.
        • Sant'Anna S.
        • Johnson C.
        Clinical perspective of the treatment of fifth metatarsal fractures.
        J Am Podiatr Med Assoc. 1995; 85: 473-480
        • Buddecke D.E.
        • Polk M.A.
        • Barp E.A.
        Metatarsal fractures.
        Clin Podiatr Med Surg. 2010; 27: 601-624
        • Aynardi M.
        • Pedowitz D.I.
        • Saffel H.
        • Piper C.
        • Raikin S.M.
        Outcome of nonoperative management of displaced oblique spiral fractures of the fifth metatarsal shaft.
        Foot Ankle Int. 2013; 34: 1619-1623
        • Clapper M.F.
        • O'Brien T.J.
        • Lyons P.M.
        Fractures of the fifth metatarsal: analysis of a fracture registry.
        Clin Orthop Relat Res. 1995; 315: 238-241
        • Konkel K.F.
        • Menger A.G.
        • Retzlaff S.A.
        Nonoperative treatment of fifth metatarsal fractures in an orthopaedic suburban private multispeciality practice.
        Foot Ankle Int. 2005; 26: 704-707
        • O'Malley M.J.
        • Hamilton W.G.
        • Munyak J.
        Fractures of the distal shaft of the fifth metatarsal: dancer's fracture.
        Am J Sports Med. 1996; 24: 240-243
        • Shereff M.J.
        Complex fractures of the metatarsals.
        Orthopedics. 1990; 13: 875-882
        • Zwitser E.W.
        • Breederveld R.S.
        Fractures of the fifth metatarsal: diagnosis and treatment.
        Injury. 2010; 41: 555-562
        • Prisk V.R.
        • O'Loughlin P.F.
        • Kennedy J.G.
        Forefoot injuries in dancers.
        Clin Sports Med. 2008; 27: 305-320
        • Krannitz K.W.
        • Fong H.W.
        • Fallat L.M.
        • Kish J.
        The effect of cigarette smoking on radiographic bone healing after elective foot surgery.
        J Foot Ankle Surg. 2009; 48: 525-527
        • Goulart M.
        • O'Malley M.J.
        • Hodgkins C.W.
        • Charlton T.P.
        Foot and ankle fractures in dancers.
        Clin Sports Med. 2008; 27: 295-304
        • Hardaker Jr., W.T.
        Foot and ankle injuries in classical ballet dancers.
        Orthop Clin North Am. 1989; 20: 621-627
        • Rammelt S.
        • Heineck J.
        • Zwipp H.
        Metatarsal fractures.
        Injury. 2004; 35: SB77-SB86
        • Soave R.L.
        • Bleazey S.
        • Rudowsky A.
        • Clarke R.V.
        • Avino Jr., A.
        • Kuchar D.J.
        A new radiographic classification for distal shaft fifth metatarsal fractures.
        J Foot Ankle Surg. 2016; 55: 803-807
        • Yoho R.M.
        • Carrington S.
        • Dix B.
        • Vardaxis V.
        The association of metatarsus adductus to the proximal fifth metatarsal Jones fracture.
        J Foot Ankle Surg. 2012; 51: 739-742
        • Kane J.M.
        • Sandrowski K.
        • Saffel H.
        • Albanese A.
        • Raikin S.M.
        • Pedowitz D.I.
        The epidemiology of fifth metatarsal fracture.
        Foot Ankle Spec. 2015; 8: 354-359
        • Hasselman C.T.
        • Vogt M.T.
        • Stone K.L.
        • Cauley J.A.
        • Conti S.F.
        Foot and ankle fractures in elderly white women Incidence and risk factors.
        J Bone Joint Surg Am. 2003; 85: 820-824