Essential Insights On Treating Fifth Metatarsal Fractures

By Nicholas Romansky, DPM, and Todd Becker, DPM
Accordingly, intramedullary screw fixation may be a more suitable option. In addition, long-term immobilization and rest can lead to muscle atrophy and stiffness, thus leading to a long recovery before the patient can achieve full athletic participation. In the athletic and active population, one must consider ORIF as a primary treatment option for Jones type fractures whereas cast immobilization may be more appropriate for the elderly and sedentary population. Late bone grafting may be necessary for avascular nonunions and severe comminution with autogenous grafting from the tibia or calcaneus. Fractures of the base of the fifth metatarsal may require ORIF only in the presence of articular involvement or distraction. It is also important postoperatively to consider the use of orthotics or shoe gear modifications to decrease the possibility of recurrent fracture. Some have also proposed that low-intensity ultrasound or other forms of bone stimulation may be beneficial in accelerating the healing time for delayed and non-unions but further research is still necessary in this area. Dr. Romansky is a Fellow of the American College of Foot and Ankle Surgeons and is a Diplomate of the American Board of Podiatric Surgery. He is a team physician for the United States Olympic and World Cup Men’s and Women’s soccer teams. Dr. Romansky is in private practice in Media and Phoenixville, Pa. Dr. Becker is a third-year resident at Crozer Keystone Health System in Pennsylvania. References 1. Ebraheim NA, Haman SP, Lu J, Padanilam TG, Yeasting RA. Anatomical and radiographical considerations of the fifth metatarsal. Foot Ankle International. 2000; 21:212-215. 2. Donley BG, McCollum MJ, Murphy A, Richardson G. Risk of sural nerve injury with intramedullary screw fixation of fifth metatarsal fractures: a cadaver study. Foot Ankle International. March 1999; 20(3):182-184. 3. Delee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med. 1983; 11:349-353. 4. Torg JS. Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics. 1990; 13:731-737. 5. Jones R. Fractures of the base of the fifth metatarsal by indirect violence. Annals Surg. 1902; 35:697-702. 6. Stewart IM. Jones’ fractures: fractures of the base of the fifth metatarsal. Clin Orthopedics. 1960; 16:190-198. 7. Yu WD, Shapiro MS. Fractures of the fifth metatarsal. The Physician and Sports Medicine. Feb.1998; 26(2). 8. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg. 1978; 60(A):776-782. 9. Portland G, Kelikian A, Kodros S. Acute surgical management of Jones Fractures. Foot Ankle International. Nov. 2003: 24(11) 10. Pietropaoli MP, Wnorowski DC, Werner FW, Fortino MD. Intramedullary screw fixation of Jones fractures: a biomechanical study. Foot Ankle International. September 1999; 20(9):560-563. 11. Shah SN, Knoblich GO, Lindsey DP, Kreshak J, Yerby SA, Chou LB. Intramedullary screw fixation of proximal fifth metatarsal fractures: a biomechanical study. Foot Ankle Int. 2001 Jul;22(7):581-4. 12. Kelly IP, Glisson RR, Fink C, Easley ME, Nunley JA. Intramedullary screw fixation of Jones fractures. Foot Ankle International. July 2001; 22(7):585-589. 13. Husain ZS, DeFronzo DJ. A Comparison of bicortical and intramedullary screw fixations of Jones fractures. J Foot Ankle Surg. May/June 2002; 41:146-153. Additional References 13. Brown SR, Bennett CH. Management of proximal fifth metatarsal fractures in the athlete. Sports Med. April 2005; 16(2):95-99. 14. Johnson JT, Labib SA, Fowler R. Intramedullary screw fixation of the fifth metatarsal: an anatomic study and improved technique. Foot Ankle International. April 200; 25(4):274-277. 15. Porter DA, Duncan M, Meyer S. Fifth metatarsal Jones fracture fixation with a 4.5 mm cannulated stainless steel screw in the competitive and recreational athlete. Am J Sports Med. 2005; 33(5):726-733. 16. Vogler HW, Westlin N, Mlodzienski AJ, Moller FB. Fifth metatarsal fractures: biomechanicics, classification and treatment. Clin Podiatric Med Surg. October 1995; 12(4):725-747.


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