Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2016; 7(12): 793-800
Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.793
Fifth metatarsal fractures and current treatment
Julia Bowes, Richard Buckley
Julia Bowes, Department of Surgery, Division of Orthopedics, Walter Mackenzie Centre, University of Alberta, Edmonton, AB T6G 2B7, Canada
Richard Buckley, Department of Surgery, Section of Orthopedics, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 5A1, Canada
Author contributions: Bowes J performed the majority of the writing; Buckley R designed the manuscript outline, contributed to the writing and preformed the majority of the editing.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Julia Bowes, MD, Department of Surgery, Division of Orthopedics, Walter Mackenzie Centre, University of Alberta, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada. jbowes@ualberta.ca
Telephone: +1-587-9897970
Received: June 27, 2016
Peer-review started: June 29, 2016
First decision: August 5, 2016
Revised: September 15, 2016
Accepted: October 5, 2016
Article in press: October 7, 2016
Published online: December 18, 2016
Abstract

Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literature on management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

Keywords: Metatarsal fractures, Fifth metatarsal, Jones fracture, Operative care, Athlete

Core tip: Nondisplaced fifth metatarsal fractures can be treated nonoperatively depending on fracture location and patient factors. When nonoperative management is utilized improved early functional scores are associated with less rigid immobilization and a shorter period of nonweightbearing. Neck and shaft fractures with greater than ten degrees plantar angulation or three millimeters of displacement in any plane where closed reduction is insufficient require operative management. Operative intervention is recommended for base of the fifth metatarsal avulsion fractures (zone one) with more than three millimeters of displacement. Acute and delayed union zone two fractures may be managed nonoperatively but operative management with an intramedullary screw should be considered in athletes. Zone three (diaphyseal stress fractures) fractures that are Torg type I and type II should be managed with intramedullary screw fixation in the athlete. In the non-athlete these fractures may be managed nonoperatively however prolonged immobilization is often required and a nonunion may still result. Symptomatic nonunions of zone two and zone three fractures should be managed operatively.