Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.793
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
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.
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.