A Closer Look At Fixation For Fifth Metatarsal Fractures

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Author(s): 
Lawrence Fallat, DPM, FACFAS, and Ruby Chahal, DPM

   Diaphyseal fractures are almost always displaced and unstable. One can achieve stable fixation for most patients by using an inexpensive quarter tubular plate with 2.7 mm cortical bone screws. For patients with increased BMI or osteoporotic bone, the surgeon can use either a one-third tubular plate with 3.5 mm cortical bone screws or a locking plate.

In Summary

Although many different types of fixation have been advocated for fifth metatarsal fractures, we have reviewed the basic types of fixation that have given us the most consistent outcomes. Selection of fixation for a fracture is always the surgeon’s preference.

   Dr. Fallat is the Program Director of the Podiatric Surgery Residency at the Oakwood Annapolis Hospital within the Oakwood Healthcare System in Wayne, Mich. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Chahal is a second-year podiatric surgery resident at the Oakwood Annapolis Hospital within the Oakwood Healthcare System in Wayne, Mich.

References
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2. Dameron TB. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg. 1975;57(6):788–792.
3. Theodorou DJ, Theodorou SJ, Kakitsubata Y, et al. Fracture of the proximal portion of fifth metatarsal bone: anatomic and imaging evidence of pathogenesis of avulsion of the plantar aponeurosis and the short peroneal muscle tendon. Radiology. 2003;226(3):857-865.
4. Jones R. Fracture of the base of the fifth metatarsal bone by indirect violence. Ann Surg. 1902;35(6):697-700.
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10. Pauwels VF. Uber die Bedeutung der Bauprinzipien des und Bewegungsapparates fur die Beanspruchung der Rohrenknochen [The functional significance of the apparatus for the support and movement of the long bones]. Acta Anat. 1951;12:207–227.
11. Carpenter B, Garrett A. Using a hook plate as alternate fixation for fifth metatarsal base fracture. J Foot Ankle Surg. 2003;42(5):315-316.

   For further reading, see “Essential Insights On Treating Fifth Metatarsal Fractures” in the April 2006 issue of Podiatry Today, “Current Concepts In Treating Fifth Metatarsal Fractures” in the May 2010 issue or “Rethinking Our Approach To Jones Fractures To Facilitate Shorter Post-Op Recovery” in the December 2011 issue.

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