Proximal fifth metatarsal fractures

NewsBot · Mar 14, 2023

Conservative versus Surgical Management of Fifth Metatarsal Diaphyseal Fractures: A Retrospective Review
Marc D Jones et al
J Am Podiatr Med Assoc. 2023 Jan-Feb;113(1):20-195

Background: Historically, distal fifth metatarsal diaphyseal fractures have been treated with conservative management, with only limited research evaluating surgical treatment of these fractures. This study was performed to compare surgical versus conservative treatment of distal fifth metatarsal diaphyseal fractures in athletes and nonathletes.

Methods: A retrospective review of 53 patients with surgical or conservative treatment of isolated fifth metatarsal diaphyseal fractures was performed. Data recorded included age, sex, tobacco use, diagnosis of diabetes mellitus, time to clinical union, time to radiographic union, athletic versus nonathletic status, time to return to full activity, surgical fixation method, and complications.

Results: Patients treated surgically had a mean clinical union time of 8.2 weeks, radiographic union time of 13.5 weeks, and return to activity time of 12.9 weeks. Patients treated conservatively had a mean clinical union time of 16.3 weeks, radiographic union time of 25.2 weeks, and return to activity time of 20.7 weeks. Delayed unions and nonunions occurred in 27.0% of patients (10 of 37) treated conservatively and in none in the surgical group.

Conclusions: Surgical treatment significantly decreased time to radiographic union, clinical union, and return to activity by an average of 8 weeks compared with conservative treatment. We suggest that surgical treatment of distal fifth metatarsal fractures is a viable option that may significantly decrease the patient's time to clinical union, radiographic union, and return to activity.
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NewsBot · May 22, 2023

Short-Term Outcomes of Jones Specific Implant vs. Intramedullary Screw and Plate Fixation for Proximal Fifth Metatarsal Fractures
Aman Chopra, BA et al
May 19, 2023

Although intramedullary screw fixation is commonly performed for proximal fifth metatarsal fractures, high rates of nonunion, refracture, and hardware prominence have been reported. The Jones Specific Implant (JSI) is a novel surgical implant which contours to the native curvature of the fifth metatarsal allowing for a more anatomic fixation. The purpose of this study was to compare short-term complication rates and outcomes of patients treated with the JSI to other fixation types such as plates and intramedullary screws. Electronic records were queried for adult patients with proximal fifth metatarsal fractures who underwent primary fixation from 2010 - 2021. All patients were treated by a foot and ankle fellowship-trained surgeon with intramedullary screws, plates, or JSI (Arthrex Inc., Naples, FL). Visual analog scale (VAS) and the American Orthopedic Foot and Ankle Score (AOFAS) were recorded and compared using univariate statistics. Eighty-five patients underwent fixation using intramedullary screw (n=51, 60%), plate (n=22, 25.9%), or JSI (n=12, 14.1%) with a mean follow-up of 11.1±14.6 months. The total cohort demonstrated a significant improvement in VAS pain (p < 0.0001) as well as AOFAS (p < 0.0001) scores. When comparing the cohort treated with JSI and the cohort treated with all other types of fixation, there were no significant differences in postoperative VAS or AOFAS scores. Only three complications, one with JSI, (3.5%) required removal of the symptomatic hardware. The JSI is a novel treatment for proximal fifth metatarsal fractures, with similar early outcomes and complication rates when compared with intramedullary screw and plate fixation.
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NewsBot · Jun 6, 2023

Anatomic variants affecting the surgical treatment of Jones fractures: A report of 3 cases
Amber M. Kavanagh, DPM, AACFAS, Brian J. Burgess, DPM, FACFAS
May 31, 2023

A Jones fracture is classified as a break that occurs at the proximal diaphyseal and metaphyseal junction of the fifth metatarsal. Higher rates of nonunion are reported with nonsurgical management of this fracture, therefore surgical intervention is recommended. In this case series, we present several unique patients who sustained a Jones fracture, but had bony ossicles or deformity that were complicating factors to surgical treatment. On radiographic evaluation, these bony abnormalities included an os vesalianum, a hypertrophic peroneal tubercle, and severe metatarsus adductus. All of the patients underwent surgical intervention with intramedullary screw placement for fixation across the fracture. Surgical planning to avoid these bony ossicles and adapt to deformities was successful in all cases. We present these three cases to illustrate surgical tips on how to successfully manage Jones fractures when bony abnormalities are present.
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NewsBot · Jun 13, 2023

Short term clinical and patient reported outcomes following Virtual Fracture Clinic management of fifth metatarsal fractures
Richard Galloway et al
Injury. 2023 Jun 4

Introduction: Fracture clinics are experiencing increased referrals and decreased capacity. Virtual fracture clinics (VFC) are an efficient, safe, and cost-effective solution for specified injury presentations. There is currently a lack of evidence to support the use of a VFC model in the management of 5th metatarsal base fractures. This study aims to assess clinical outcomes and patient satisfaction with the management of 5th metatarsal base fractures in VFC. We hypothesise that it is both safe and cost effectiveness.

Methods: Patients presenting to VFC at our major trauma centre with a 5th metatarsal base fracture, between January 2019 and December 2019, were included. Patient demographics, clinic appointments, complication and operative rates were analysed. Patients received standardised VFC treatment; walker boot/full weight bearing, rehabilitation information and instructions to contact VFC if symptoms of pain persist after 4 months. Minimum follow-up was one year; Manchester-Oxford Foot Questionnaires (MOXFQ) were distributed. A basic cost analysis was performed.

Results: 126 patients met inclusion criteria. Mean age was 41.6 years (18-92). Average time from ED attendance to VFC review was 2 days (1 - 5). Fractures were classified according to the Lawrence and Botte Classification with 104 (82%) zone 1 fractures, 15 (12%) zone 2 fractures and 7 (6%) zone 3 fractures. At VFC, 125/126 were discharged. 12 patients (9.5%) arranged further follow-up after initial discharge; pain the reason in all cases. There was 1 non-union during the study period. Average MOXFQ score post 1 year was 0.4/64, with only 11 patients scoring more than 0. In total, 248 face-to-face clinic visits were saved.

Conclusion: Our experience demonstrates that the management of 5th metatarsal base fractures in the VFC setting, with a well-defined protocol, can prove safe, efficient, cost effective and yield good short term clinical outcomes.
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NewsBot · Nov 21, 2023

Compression screw internal fixation versus non-weight-bearing cast immobilization for Jones fractures in children
Yuwei Wen et al
Injury. 2023 Nov 14;55(2):111213

Background: Several methods have been used to treat pediatric Jones fractures, but there has been no consensus about the optimum method. The purposes of this study were to compare the clinical outcomes between compression screw and non-weight-bearing techniques used in pediatric Jones fractures and clarify the most suitable treatment option for this population.

Methods: Twenty-one patients who presented with Jones fractures between January 2015 and June 2021 were analyzed retrospectively. They were divided into the compression screw group (n=10) and cast immobilization (n=11) group. The following parameters were compared between them: demographic data; times to radiographic union, full weight bearing, and return to daily life; and the American Orthopaedic Foot and Ankle Society (AOFAS) foot scores at 3 months postoperatively and the final follow-up.

Results: The two groups did not differ significantly with respect to age, sex, laterality, and preoperative displacement. The mean immobilization time and times to radiographic union, full weight bearing, and return to daily life were significantly shorter in the compression screw group than in the cast immobilization group. The AOFAS scores at the final follow-up did not differ significantly between the two groups. One case of refracture and delayed union each were observed in the non-weight-bearing cast group. However, no patients experienced nonunion.

Conclusions: Compression screw and non-weight-bearing cast techniques are effective methods for treating pediatric Jones fractures. The complication rate was lower in pediatrics than in adults. However, compared with the non-weight-bearing cast technique, the compression screw technique has the advantages of a shorter radiographic union time, shorter immobilization times, and earlier return to full weight bearing and daily life. We recommend compression screw fixation for widely displaced fractures and school-age and active adolescents to avoid delays in healing, nonunion, disruption to daily living, and time off school.
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NewsBot · Dec 11, 2023

New Classification for Pediatric Proximal Fifth Metatarsal Fractures
Hannah A. Lee, BA et al
December 03, 2023

Proximal fifth metatarsal fractures are the most common foot fractures in children. Attempts to classify these injuries are misapplied and inadequately predict outcomes. This is the first study to identify factors associated with healing in pediatric fifth metatarsal fractures. In this retrospective cohort study (N=305), proximal fifth metatarsal fractures were classified on radiographs by location on the bone, alignment (transverse or oblique), displacement (>2mm), and completion through the bone. Based on literature, they were secondarily sorted by category: apophyseal, intra-articular metaphyseal, extra-articular metaphyseal, and diaphyseal. Primary outcomes included times to healing, indicated by clinical symptoms, immobilization, and return to sports, as well as radiographic callus formation, bridging, and remodeling. Healing times were compared by ANOVA and linear regression. Location had a significant effect on times of immobilization and to return to sports, but alignment, displacement, and completion were not associated with healing. When re-classified, the categories were also associated with immobilization and return to sports. Apophyseal fractures healed fastest and diaphyseal fractures required the most time to heal. There was no difference between extra- and intra-articular fractures. For every year of age, symptoms resolved about 2 days sooner. Neither gender nor body mass index (BMI) were positively or negatively associated with healing times. In conclusion, classifying fractures by apophyseal, metaphyseal, and diaphyseal is the most concise, accurate, and useful system. This is the largest series of non-operatively treated proximal fifth metatarsal fractures in children and a robust standard to which surgical management can be compared.
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NewsBot · Jan 8, 2024

Jones Fracture in the National Football League
Emily J. Luo et al
Sports 2024, 12(1), 7

Background: Jones fracture, or proximal fifth metatarsal fracture, is a common injury in National Football League (NFL)-caliber athletes. Combine draft performance can greatly impact the long-term success of these athletes, and substantial emphasis has been placed on early return to play (RTP) and the minimization of post-operative complications after Jones fracture in these athletes. To date, no study has specifically described the treatment and outcomes of this injury specifically in NFL-caliber players, considering factors relevant to this unique population. Thus, the purpose of this review is to delve into Jones fracture in NFL-caliber athletes, evaluating the diagnostic, treatment, and RTP considerations. Methods: We searched Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCOhost) for the concept of Jones fractures in the NFL. Using the PRISMA guidelines, a team of three reviewers conducted abstract screenings, full-text screenings, and the extraction of studies describing Jones fractures specifically in the NFL. Results: Of the 1911 studies identified, 6 primary retrospective studies met the inclusion and exclusion criteria. The heterogeneity of the outcome reporting precluded a meta-analysis; thus, a qualitative review of manuscripts describing Jones fracture was carried out. Classification, diagnosis, and treatment considerations, RTP statistics and outcomes, and complications were discussed. Amongst the primary studies, there were 285 Jones fractures, all athletes were able to RTP, and the average time to RTP ranged from 6 weeks to 27 weeks. For complications, with operative treatment, the refracture rate ranged from 4 to 12%, and incomplete healing ranged from 7 to 50%. RTP was 15 weeks for refractures. There were no patient-reported outcomes. Conclusions: The vast majority of Zone 2/3 Jones fractures are treated with IM screw fixation with or without adjunctive orthobiologics, such as bone marrow aspirate concentrate, in NFL-caliber athletes. The six major series investigating outcomes after the operative treatment of Jones fractures in NFL players reveal very positive findings overall with regard to RTP, reoperation, and career continuation.
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NewsBot · Apr 3, 2024

Is Surgical Treatment Necessary for the Treatment of a Jones Fracture?: A Retrospective Study
Changsu Kim et al
Clin Orthop Surg. 2024 Apr;16(2):335-341

Background: Jones fractures are common injuries that can be treated conservatively or surgically. However, the optimal treatment approach remains controversial. This study aimed to compare the clinical outcomes of conservative and operative treatments for Jones fractures and determine whether surgical treatment is necessary.

Methods: A retrospective study was conducted on 69 patients with Jones fractures treated at our hospital. The patients were divided into 2 groups: conservative (C group; n = 46) and operative (O group; n = 23) treatments. Patients were followed up after 2, 6, and 12 weeks, and every 3 months thereafter. However, outpatient follow-ups were conducted between 8 and 10 weeks as needed. The mean follow-up period was 14.5 weeks (range, 12-24 weeks). In group C, the patients were treated with a non-weight-bearing cast for 4-6 weeks, followed by additional weight-bearing boot immobilization before returning to exercise. In group O, patients were treated surgically using a bicortical screw or intramedullary internal fixation. Time to radiologic union, clinical union, return to sports, visual analog scale (VAS), Foot Function Index-Revised Short Form (FFI-RS), and American Orthopedic Foot and Ankle Society (AOFAS) scores were evaluated.

Results: Sixty-nine patients were included in the analysis. There were statistically significant differences in the time to radiologic union and return to sports, VAS score in the second week, and FFI-RS score in the 12th week. In group C, favorable outcomes were observed in terms of the time to return to sports, VAS score in the second week, and FFI-RS score in the 12th week. Contrastingly, in group O, better results were observed in time to radiologic union. The AOFAS score was excellent at the final follow-up, with no significant differences between groups. Complication rates were 10.8% and 13% in groups C and O, respectively.

Conclusions: Surgical treatment is sometimes necessary for Jones fractures, but conservative treatment should also be considered because of the favorable outcomes. Conservative treatment can be a good option for patients who are risk-averse and place a high value on fracture healing without surgery.
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NewsBot · Apr 4, 2024

Functional outcome and risk of non-union for 5th metatarsal base fractures
Ethan Toner et al
Eur J Orthop Surg Traumatol. 2024 Apr 3

Objectives: Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up.

Methods: 194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service.

Results: Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery.

Conclusion: The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.
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NewsBot · Apr 22, 2024

Effectiveness of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the fifth metatarsal base
Hongtao Jiang et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Apr 15;38(4):444-447

Objective: To explore the effectiveness of transverse double "8"-shaped tension band technique in the treatment of Lawrence zoneⅠfracture of the 5th metatarsal base.

Methods: Between February 2019 and October 2021, 15 patients with Lawrence zoneⅠfracture of the 5th metatarsal base were treated with transverse double "8"-shaped tension band technique. There were 8 males and 7 females, with a median age of 40 years (range, 23-59 years). The fractures were caused by sprains. The time from injury to operation was 3-7 days (mean, 4.1 days). X-ray films were taken to observe the fracture healing and the anchor looseness and detachment. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, and the eversion angle of the calcaneal talus joint.

Results: The incisions healed by first intention after operation in 14 cases and the incision healed poorly in 1 case. All patients were followed up 8-12 months (median, 10 months). The imaging examination showed that all fractures healed well, with a healing time of 10-14 weeks (mean, 11.7 weeks). At last follow-up, AOFAS score was 82-100 (median, 98); 13 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. VAS score was 0-3 (median, 1). Three cases had mild limited ankle joint range of motion, while 12 cases had normal range of motion. The eversion angle of the calcaneal talus joint was 25°-32° (median, 30°).

Conclusion: The application of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the 5th metatarsal base has advantages such as simple operation, avoidance of secondary operation, and reduction of foreign body sensation, with definite effectiveness.
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NewsBot · Apr 24, 2024

Clinical and Radiographic Healing of Nonoperative and Operative Treatment of Jones Fractures
Matthew T Kingery et al
Foot Ankle Int. 2024 Apr;45(4):309-317

Background: Significant heterogeneity in the classification and treatment of zone 3 proximal fifth metatarsal base fractures ("true Jones fractures") exists. This study compared time to clinical and radiographic healing between patients treated operatively and nonoperatively. We hypothesized that patients treated nonoperatively may demonstrate a greater time to clinical healing.

Methods: This was a retrospective cohort study of patients presenting to a large, urban, academic medical center with "Jones" fractures between December 2012 and April 2022. Jones fractures were defined as fifth metatarsal base fractures occurring in the proximal metadiaphyseal region, distal to the articulation of the fourth and fifth metatarsals on the oblique radiographic view. Clinical healing was the time point at which the patient had returned to their baseline ambulatory status with no tenderness to palpation. Radiographic healing was the presence of bridging callus across at least 3 cortices.

Results: A total of 2450 patients presented with fifth metatarsal fractures, and 166 fractures (6.8%) were true Jones fractures. Among patients with Jones fractures, 120 patients with 121 Jones fractures followed up at our institution and were included in the analysis (mean age 46.5 ± 18.5 years). Ninety-nine fractures (81.8%) were treated nonoperatively and 22 fractures (18.2%) operatively. There were no differences between nonoperative and operative groups in time to clinical healing (12.7 ± 7.1 vs 12.8 ± 4.8 weeks, P = .931) or radiographic healing (13.2 ± 8.1 vs 11.7 ± 5.9 weeks, P = .331). Overall healing rate was 96% for the nonoperative group compared with 96.2% for the operative group.

Conclusion: In this study, nonoperative and operative treatment of true Jones fractures were associated with equivalent clinical and radiographic healing. The rate of delayed union in true Jones fractures was lower than previously described, and there was no difference in delayed union rate between nonoperative and operative management.
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NewsBot · Jun 12, 2024

Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study
Erdi Imre, Bilgin Bozgeyik, Onur Kaya
Foot (Edinb). 2024 May 29

Background: Fifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures.

Methods: Patients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1-2, 4-5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups.

Results: The fracture group demonstrated a significantly lower 4-5 intermetatarsal and calcaneal inclination angles than the control group (p < 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle.

Conclusion: This study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4-5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies.
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NewsBot · Sep 7, 2024

Effect of Patient Age on Fifth Metatarsal Fracture Pattern, Management, and Outcomes
Manasa L. Kadiyala, MD et al
Source

Patients with 5th metatarsal (MT) fractures encompass a broad age distribution. This study evaluated the impact of age on the differences in clinical outcomes and management of these fractures. This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital system with a 5th MT fracture over a 10-year period. Patients were stratified into groups of younger than 65 years old and equal to or greater than 65 years old. Initial and successive radiographs were reviewed, and fractures were categorized as Zone 1, Zone 2, Zone 3, Shaft, Neck, or Head fractures. 2,461 patients with 5th MT fractures were evaluated. Patients who did not follow up after initial evaluation in the emergency department or urgent care were excluded. Among 2,020 patients with mean follow-up of 1.03 years who met inclusion criteria, 76.2% were younger than 65 years and 23.8% were greater than or equal to 65 years. There was a significant difference in fracture type between groups as older patients were more likely to sustain metatarsal neck fractures but less likely to sustain Zone 1 base fractures (p < 0.05). There was no difference in time to clinical healing (p = 0.108) or time to radiographic union (p = 0.367) for all fractures between age groups. In conclusion, older patients sustain different 5th metatarsal fracture patterns compared to younger patients. However, despite the differences in age, there was no evidence for any difference in clinical and radiographic outcomes between groups.
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NewsBot · Sep 21, 2024

Management of zone 2 fifth metatarsal fractures varies based on treating specialty
Matthew T Kingery et al
Bone Joint J. 2024 Sep 1;106-B(9):942-948

Aims: This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures.

Methods: This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64).

Results: Overall, 281 patients (57.7%) were treated by orthopaedic surgeons, and 206 patients (42.3%) by podiatrists. When controlling for age, sex, and time between symptom onset and presentation, the likelihood of undergoing operative treatment was significantly greater when treated by a podiatrist (odds ratio (OR) 2.9 (95% CI 1.2 to 8.2); p = 0.029). A greater proportion of patients treated by orthopaedic surgeons were allowed to immediately bear weight on the injured foot (70.9% (178/251) vs 47.3% (71/150); p < 0.001). Patients treated by podiatrists were immobilized for significantly longer (mean 8.4 weeks (SD 5.7) vs 6.8 weeks (SD 4.3); p = 0.002) and experienced a significantly longer mean time to clinical healing (12.1 (SD 10.6) vs 9.0 weeks (SD 7.3), p = 0.003).

Conclusion: Although there was considerable heterogeneity among zone 2 fracture management, orthopaedic surgeons were less likely to treat patients operatively and more likely to allow early full weightbearing compared to podiatrists.
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NewsBot · Oct 12, 2024

Is the Diagnosis of fifth Metatarsal Fracture Type Consistent? An Interobserver Reliability Study
James Chapman et al
Foot Ankle Orthop. 2024 Sep 30;9(3)

Background: Treatment pathways of fifth metatarsal fractures are commonly directed based on fracture classification, with particular proximal fractures typically requiring closer observation and possibly more aggressive management. Our aim is to investigate the interobserver reliability of assessment of subtypes of fifth metatarsal fractures.

Methods: We included all patients referred to our virtual fracture clinic with a suspected or confirmed fifth metatarsal fracture. Plain anteroposterior radiographs were reviewed by 2 novice observers, initially trained on the fifth metatarsal classification identification. Eight different zones were defined based on anatomical location. Patients were excluded from analysis if neither observer could identify a fracture. An interobserver reliability analysis using Cohen κ coefficient was carried out, and degree of observer agreement described using Landis and Koch's description. All data were analyzed using IBM SPSS, version 27.

Results: A total of 1360 patients who met the inclusion criteria were identified. The 2 observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and distal metaphysis (DM) fractures, which only achieved fair agreement (κ = 0.308 and 0.381 respectively). Zone 3 has slight agreement with zone 2 proximally, and there is an apparent difficulty with distal diaphyseal shaft (DS) fractures, resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; κ = .398, P < .001).

Conclusion: Reliability of subcategorizing fifth metatarsal fractures using standardized instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow-up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration.
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NewsBot · Oct 20, 2024

An overview of the risk factors for producing fifth metatarsal fracture in sports activities: A systematic review
Luis Angel Ortiz-Lango et al
J Foot Ankle Res. 2024 Dec;17(4):e70012

Introduction: The fifth metatarsal fracture is a foot injury that occurs in sports activities. This fracture has been associated with risk factors based on intrinsic variables such as type of feet (flatfoot or cavus foot), foot pathologies, and bone density among others. Extrinsic variables associated with fifth metatarsal fractures include sports maneuvers, the type of sports practice, and contact surface. Although this injury has been investigated over the years, there is no consensus on the most relevant risk factors that cause this injury. An increase in the number of people with fractures makes it a relevant topic of research. The objective of this review was to identify an overview of the risk factors for producing the fifth metatarsal fracture based on intrinsic and extrinsic variables in sports activities. Furthermore, this review aimed to clarify what is known and what is needed on the risk factors that can influence the appearance of the fracture.

Methods: A search in electronic databases, such as Scopus (n = 87), PubMed (n = 187), and Web of Science (n = 173) was conducted. The initial search yielded 447 titles and abstracts, from which 31 papers were selected for detailed analysis after screening all citations against the eligibility criteria.

Results: After screening the manuscripts, it was found that the fifth metatarsal fracture can be produced by multiple factors. However, most of the studies focus on one or two specific risk factors. It was found that soccer (38.7%) is the sports activity that presents a higher risk of getting a fifth metatarsal fracture compared to other sports activities. The second risk factor was the performance of critical maneuvers (22.5%) and the third one was the biomechanics of the foot (22.5%).

Conclusion: It is paramount to identify the most critical risk factors linked to the fifth metatarsal fracture to be able to implement effective treatments and prevention strategies.
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NewsBot · Nov 18, 2024

Percutaneous Screw Fixation of Proximal Fifth Metatarsal Fractures
Cuyler P Dewar et al
JBJS Essent Surg Tech. 2024 Nov 15;14(4):e23.00078.

Metatarsal fractures are one of the most common injuries of the foot, accounting for approximately 5% to 6% of all fractures confronted in the outpatient setting1. Approximately 45% to 70% of these fractures involve the fifth metatarsal, which have been described using a 3 zonal approach in 1993 by Lawrence and Botte2. Zone 2 fractures are difficult to manage given their retrograde vascular supply, leading to higher rates of nonunion1,3. Jones fractures (zone 2) are primarily treated surgically, with the 2 main methods being intramedullary screw fixation and plate fixation3. Surgical management leads to higher rates of union when compared with nonoperative modalities. Presented here is a technique for zone 2 intra-articular Jones fractures with minimal to moderate displacement via open reduction and internal fixation. This technique is not recommended for comminuted fractures or those with proximal split fractures. Starting with the foot lateral, this technique requires meticulous marking of the anatomical landmarks of the distal fibula as well as the fifth metatarsal to establish the precise starting point for the guidewire. Using a mini c-arm, a high and inside positioning should be confirmed prior to advancing the guidewire from proximal to distal while remaining positioned in the center of the medullary canal. Capitalizing on the variable pitch of a 5.0-mm headless compression screw, the Jones fracture is compressed to ensure primary bone healing. The incision is then closed, and a soft wrap is utilized followed by 2 weeks of non-weight-bearing and progressive protective weight-bearing until a complete recovery is achieved.

Background: Open reduction and internal fixation (ORIF) for the operative treatment of zone-2 intra-articular Jones fractures with minimal to moderate displacement is recommended because of the high rate of nonunion associated with nonoperative treatment. The blood supply to this region is minimal because of its retrograde flow, leading to high rates of nonunion with nonoperative treatment. The presently described technique offers reduction and fixation of a zone-2 fracture, as well as improved functional outcomes and nonunion rates. This approach is minimally invasive, as it is performed percutaneously, leading to a decrease in soft-tissue damage, infection rates, and operative time.

Description: The zone-2 fifth metatarsal ORIF technique begins with the use of a marking pen to outline the distal fibula and the head of the fifth metatarsal for proper orientation. Fluoroscopy is utilized to identify the landmarks so that a guidewire can be placed into the proximal dorsal aspect of the fifth metatarsal. Placement is confirmed on multiple radiographic images. The guidewire is then slowly inserted down the medullary canal of the fifth metatarsal, with placement verified on multiple fluoroscopic images. Once placement is confirmed, screw size is estimated with use of radiographic measurements. An incision is made bluntly and dissected down, going high and medial in order to protect the sural nerve and the peroneus brevis tendon insertion. The path is then drilled with use of a cannulated screw system. Biomechanically, a full-core screw is preferable, ranging from 4.5 to 5.5 mm depending on the canal diameter. For the example procedure shown in the video, a full-core 5-mm screw was inserted until appreciable reduction of the fracture was observed on fluoroscopic visualization, with additional confirmation on multiple radiographic views. Once satisfied with the placement, the guidewire is removed and the site is irrigated and closed with use of 3-0 nylon suture. A weight-based combination of short and long-acting local anesthetics (ropivacaine and lidocaine) is then injected around the incision site as part of a postoperative multimodal pain regimen. The area is then cleaned and dried. Xeroform, 4 × 4s, Army battle dressings, and a soft wrap are then applied, followed by a postoperative boot.

Alternatives: Poor surgical candidates include those with neuropathic feet, local infection, presence of severe vascular insufficiency, and comorbidities that would make surgery dangerous. Such patients can undergo nonoperative treatment, which includes 4 to 6 weeks of non-weight-bearing in a cast until union is confirmed radiographically. Once union is confirmed, patients undergo 4 to 6 more weeks of weight-bearing in a boot. One meta-analysis found that nonoperative treatment led to nonunion rates between 15% and 30%, notably higher than with operative treatment (0% to 11%)6. Most cases of zone-2 fifth metatarsal fracture are treated operatively, with intramedullary screw or plate fixation being the primary techniques. Intramedullary screw fixation is the technique featured in the present video, and offers the advantage of decreased soft-tissue injury, infection, and operative time because of its percutaneous approach. Percutaneous screw fixation is not recommended for comminuted fractures or those with proximal-split fracture patterns7,8. Fractures with these patterns should be critically evaluated with additional radiographic work-up. ORIF utilizing hook plates or fracture-specific plate implants may be warranted in these cases. In cases of chronic nonunion or fractures with sclerotic margins, an additional percutaneous incision over the fracture site is recommended to fenestrate the fracture edges and allow bone grafting prior to screw insertion7,8.

Rationale: ORIF of zone-2 intra-articular Jones fractures with minimal to moderate displacement with use of an intramedullary screw is a low-risk and highly successful surgical approach to these common fractures. Because of the watershed region at zone 2 of the fifth metatarsal, nonunion rates with nonoperative treatment are relatively high (between 15% and 30%)4,6. Another study of 22 patients showed a 100% union rate following operative treatment of acute Jones fracture5. These studies, along with others, provide strong evidence to suggest the benefit of early operative treatment with use of screw fixation, as compared with nonoperative treatment.

Expected outcomes: Postoperatively, these patients are managed with a standard protocol established by our institution. The first 2 weeks include being in a soft wrap and postoperative boot while being non-weight-bearing. The patient should keep the incision clean and dry, elevate the foot/ankle often, and follow activity guidelines. Sutures are removed at 2 to 6 weeks postoperatively, and the boot should be used for all weight-bearing ambulation, with crutches being utilized for the transition. Additionally, ankle range-of-motion exercises and strengthening should begin. Weight-bearing should transition as follows: 25% at week 3, 50% at week 4, 75% at week 5, and 100% at week 6. At weeks 6 to 8, walking and physical therapy should be increased and previous exercises should be continued. At weeks 8 to 12, pool or treadmill activity should begin, and it should be increased thereafter. Patients should expect evidence of radiographic union between weeks 6 and 10, with a meta-analysis showing union rates with screw fixation between 89% and 100%6.

Important tips: Guidewire insertion should be proximal and dorsal, allowing the guidewire to enter at the high and inside position. To do so, palpate the proximal aspect of the fifth metatarsal and outline the contour on the skin, then mark the incision 1 to 3 cm proximal to this to avoid unnecessary soft-tissue tension and potential wound issues. This incision is parallel and generally inferior to the sural nerve, but arborization and branching are highly variable. Utilizing a high and inside starting point avoids the more lateral and plantar insertion of the peroneus brevis. The high and inside starting point is verified under anteroposterior, lateral, and oblique radiographic views. This position biomechanically avoids plantar gapping and reduces the risk to soft-tissue structures.Utilizing a mini c-arm or fluoroscopy unit allows multiple views for ideal screw alignment to be obtained quickly, with decreased radiation exposure.Utilizing an all-cannulated system allows for a seamless transition from drilling to screw placement.Avoid making the incision too close to the proximal aspect of the fifth metatarsal, as this would cause unnecessary soft-tissue tension and potential wound issues. The incision should be made 1 to 3 cm proximal to the proximal aspect of the fifth metatarsal.Use adequate soft-tissue retraction, as protecting the sural nerve is paramount during screw insertion.Do not allow the patient to be weight-bearing immediately. We strongly recommend that the patient be non-weight-bearing for 2 weeks and then perform progressive protected weight-bearing in a postoperative boot for 4 weeks.
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NewsBot · Nov 28, 2024

Fifth metatarsal fractures: Review of the current concepts
Amr Eldessouky et al
J Arthrosc Surg Sports Med. doi: 10.25259/JASSM_34_2024

Fractures of the fifth metatarsal are among the most common injuries in the foot, often presenting significant challenges for treatment, particularly when they occur at the base. This area is especially problematic due to its unique blood supply, which can result in delayed or non-union. The treatment of these fractures has been a subject of extensive debate among surgeons for many years. Various treatment approaches have been proposed, reflecting differing opinions on the best methods to ensure optimal patient outcomes. This review offers a comprehensive overview of the anatomy, classifications, and mechanisms of injury. It also discusses the different non-operative and operative approaches and highlights the latest concepts in managing fifth metatarsal fractures. The review offers valuable insights for clinicians, helping them choose the most effective treatment protocols based on the fracture type and the patient’s level of activity and needs.
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NewsBot · Dec 3, 2024

The comparative study of clinical outcomes among early functional treatment, immobilization treatment and ulnar plate fixation for displaced or comminution fifth metatarsal base fractures
Kunpeng Leng et al
J Foot Ankle Surg. 2024 Nov 30:S1067-2516(24)00282-5.

The optimal treatment for displaced or comminution fifth metatarsal base fractures remain debated. Ninety displaced or comminution fifth metatarsal base fractures patients were randomly selected into three groups: the ulnar hook plate fixation group (n=30), the immobilization treatment group (n=18), and the early functional group (n=30). The assessed factors included the duration until union, time to resume daily activities, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, visual analog scale (VAS) ratings and occurrence of complications. The VAS scores showed no significant differences observed among the three treatments. The mean AOFAS score and mean FADI after treatment in the plate group and exhibited significant better than that of the immobilization group and the early functional group at 1 moth, 3 months and 6 months (P˂0.05) . After a duration of 12 months, all three treatments exhibited comparable outcomes and facilitated restoration of daily activities. In the plate group, one patient developed a wound infection, one patient experienced sural nerve injury or irritation, and three patients exhibited implant prominence. One patient encountered nonunion in the immobilization group.The union time and the time of return to daily activities and the early functional group exhibited significant shorter durations than that of the immobilization group and the plate group(P˂0.05). Overall, the early functional treatment is recommended for managing displaced or comminution fifth metatarsal base fractures. Evidences level: III.
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NewsBot · Dec 3, 2024

Role of Hip Internal Rotation Range and Foot Progression Angle for Preventing Jones Fracture During Crossover Cutting
Yudai Kikuchi et al
Journal of Applied Biomechanics

Jones fracture is a common injury in soccer players, caused by overload on the fifth metatarsal (M5) that can occur during crossover cutting. This study aimed to investigate the effects of the hip internal rotation (HIR) range in passive and dynamic conditions and foot progression angle (FPA) on the forces applied to the M5 during crossover cutting. The study included 20 men with experience playing soccer. The passive HIR was measured in the prone position. A 3-dimensional motion analysis system, force plates, and Footscan were used to measure the angle of the lower limb, including dynamic HIR, FPA, and plantar pressure to the M5, during crossover cutting in the 45° direction. Pearson correlation coefficient was measured to examine the relationship between variables. Passive and dynamic HIR were not related to the plantar pressure on the M5 (P > .05). However, increased FPA in movement direction correlated with a reduction in plantar pressure on the M5 (r = −.56, P < .01). Minimizing the FPA with respect to the new direction during crossover cutting reduced plantar pressure on the M5 and thus could prevent Jones fracture
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NewsBot · Dec 14, 2024

Evaluating Performance Among National Basketball Association Players After Jones Fractures: A Retrospective Cohort Study
Andrew H Kim et al
Orthop J Sports Med. 2024 Dec 11;12(12)

Background: In professional basketball, Jones fractures are among the most common cause of lower extremity stress injury. Despite its prevalence, there is a paucity of research on the impact of Jones fractures on athletic performance in the National Basketball Association (NBA).

Purpose: To determine the impact of Jones fractures on return to play and performance among NBA players when compared with preinjury values and healthy matched controls.

Study design: Cohort study; Level of evidence, 3.

Methods: NBA injury reports were analyzed to identify 18 players who sustained a Jones fracture between 2011 and 2022. Reports were verified through public press releases, social media accounts, and player profiles. A publicly available database was used to collect player data including position, age, and years of NBA experience. Performance and advanced statistics were collected for seasons pre- and postinjury. Players were 1:1 matched with healthy controls based on age, player position, and career performance. Univariate and multivariable regression analyses were performed to compare advanced and per-game performance statistics between injured and healthy control players.

Results: NBA players who sustained a Jones fracture had a mean age of 23.9 ± 2.31 years at the time of injury. The mean NBA experience was 3.00 ± 2.35 years and mean preinjury minutes played per game was 19.64 ± 11.24. All players (18/18) were able to return to NBA-level competition the year following the injury. There was no change in player efficiency rating (PER), value added, and estimated wins added metrics when comparing pre- and postinjury performances among injured players. Injured players missed more games (P < .001) postinjury compared with the matched controls. Multivariate analysis revealed that for players with a height of <2 m, every additional centimeter of height significantly decreased postinjury PER by 1.08 (95% CI, 0.35-1.80; P < .01).

Conclusion: Despite its severity, most NBA players who sustain Jones fractures can return to preinjury performance and level of competition. There was no statistically significant decline in advanced statistics in the following season after injury, with a significant decrease in games played when comparing injured players with their healthy controls.
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NewsBot · Jan 2, 2025

New Classification System for Proximal Fifth Metatarsal Fractures: Intraobserver and Interobserver Reliability Assessment
Enrique Fernández-Rojas et al
Foot Ankle Int. 2025 Jan 2:10711007241303756.

Background: The most commonly used classification for proximal fifth metatarsal fractures has not shown good reproducibility. The aim of this study was to evaluate the intraobserver and interobserver agreement of a new classification system for such fractures.

Methods: The study involved the development of a novel classification system that categorized these fractures into 2 main types and 2 subtypes. This cross-sectional study included a total of 52 cases that were retrospectively collected to assess the reliability of this system. These cases were then evaluated by 3 independent foot and ankle surgeons who classified the fractures based on the newly established classification system. After 10 months, the same evaluators classified the fractures again. The level of agreement among the evaluators, both internally and externally, was assessed using the kappa coefficient, following the criteria established by Landis and Koch. This framework categorizes agreement levels as slight (0.00-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), or almost perfect (0.81-1.00).

Results: Fifty-two fractures were detected, and 312 evaluations were carried out. The interobserver agreement was substantial when assessing the 2 main types, with a κ value of 0.73, and remained substantial even when considering the subtypes, with a κ value of 0.67. Similarly, the intraobserver agreement demonstrated substantial outcomes when evaluating the 2 main types, with a κ value 0.79. It maintained its significance when including the subtypes, with a κ value 0.77.

Conclusion: Lawrence and Botte's classification identifies 3 primary zones and exhibits moderate interobserver agreement. In contrast, the newly proposed system focuses on only 2 main zones and shows better interobserver agreement. The present study introduces a more precise and reproducible framework that reveals consistency among various observers, including the same observer. This framework may be beneficial for biomedical research as it enhances the ability to compare results across different studies.
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NewsBot · May 24, 2025

Base of Fifth Metatarsal Fractures: A Meta-analysis of Plate Fixation
Keenan Horani et al
Indian J Orthop. 2025 Apr 10;59(5):569-580.

Purpose: Base of fifth metatarsal fractures are treated according to fracture zones. Proximal tuberosity avulsions (zone 1) are typically treated conservatively, while proximal metaphyseal-diaphyseal junction fractures (zone 2) or proximal diaphyseal fractures (zone 3) are usually treated with intramedullary screw fixation.

Methods: We performed a systematic review and meta-analysis of plate fixation of base of fifth metatarsal fractures by zones to estimate mean time to union, mean time to return to daily activities, mean 1-year American Orthopaedic Foot and Ankle Society (AOFAS) score, and complication rate. Outcomes were pooled to determine aggregate outcomes if standard errors were included and there were at least 2 studies.

Results: Six studies examined zone 1 and 2 fractures treated with plate fixation. Zone 1 fractures had a mean of 6.88 weeks union time, 11.34 weeks to return to daily activities, 1-year AOFAS score of 94.91, and 5.97% complications. Zone 2 fractures had a mean of 7.0 weeks union time and 20.45% complications.

Conclusion: Zone 1 and 2 plate fixation demonstrated union rates comparable to those for traditional fifth metatarsal base fracture management.
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NewsBot · May 28, 2025

Are there changes in the foot biomechanics during the before and after fifth metatarsal fracture running stance phase?
Huiyu Zhou et al
Source

The purpose of this study is to restore the before fracture kinematic state by using the observed foot bone displacements as boundary conditions for finite element (FE) analysis. Secondly, this study aims to compare the biomechanical changes of the foot before and after a metatarsal (MT) fracture using this method. A total of 21 subjects had previously experienced a shaft stress fracture of the MT5 in the six months before the collection of experimental data. All patients received treatment through the use of cast immobilization for duration of 4–6 weeks. After the subject’s recovery, we obtained gait biomechanical data. At the same time, we also obtained gait data from 21 healthy subjects as the control group. This study found that when a fracture of the MT5 occurs, even after rehabilitation, there is a significant impact on the metatarsal.
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NewsBot · Jun 13, 2025

Surgical Excision of Symptomatic Nonunions of the Fifth Metatarsal Base Fractures: A Systematic Review of Outcomes and Complications
Zack Hill et al
Foot & Ankle Surgery: Techniques, Reports & Cases

Background
Symptomatic non-unions of the fifth metatarsal base, particularly in Zones 1 and 2, pose significant treatment challenges. Surgical management includes open reduction internal fixation (ORIF) or excision of the non-union fragment. Though less technically demanding, excision procedures risk disrupting important tendon and ligamentous attachments, potentially affecting foot function.
Methods
This review synthesizes available data on surgical excision as a definitive treatment, addressing outcomes and complications. A systematic review of PubMed, Embase, Cochrane Library, and Google Scholar was performed to identify studies reporting on the excision of nonunion fragments at the proximal fifth metatarsal. Inclusion criteria required studies to present functional outcomes and complications following excision in Zones 1 and 2. Of 156 studies reviewed, 4 met the criteria, encompassing 18 patient cases.
Results
All 18 patients underwent excision of the proximal fragment, with various techniques used to preserve peroneal tendon function. Twelve patients were high-level athletes, and all returned to sport without pain or functional limitations. One study reported a significant improvement in AOFAS forefoot scores (from 58.6 to 95; p = 0.024) and VAS scores (from 8.0 to 1.6; p = 0.023). At an average follow-up of 18.3 months, 100% of patients were pain-free, and no complications were reported.
Conclusion
Excision of symptomatic non-unions of the fifth metatarsal base, particularly in Zone 1 and selective cases for Zone 2, appears to be a safe and effective treatment option, allowing for significant pain relief and return to activity in high-level athletes. Further research is needed to validate long-term outcomes and optimal surgical techniques.
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NewsBot · Jun 19, 2025

Foot Malalignment and Proximal Fifth Metatarsal Fractures
Wolfram Grün et al
Foot Ankle Int. 2025 May;46(5):561-570.

Background: Proximal fifth metatarsal fractures are common injuries that are classified into 3 zones according to their anatomical localization. While zone 1 and 2 fractures typically are traumatic, zone 3 fractures may be linked to foot alignment abnormalities, such as hindfoot varus and metatarsus adductus. The aim of the study was to explore the association between hindfoot alignment and different fracture zones, as well as the relationship between traumatic and atraumatic fracture origin and foot alignment.

Methods: We conducted a retrospective cohort study of patients with proximal fifth metatarsal fractures who had received a weightbearing computed tomography (WBCT) scan. Feet with zone 1 and 2 fractures were compared to zone 3 fractures and a healthy control group. Additionally, we compared feet with a traumatic fracture origin with those without. Foot alignment parameters, including the foot and ankle offset (FAO) and the forefoot arch angle (FAA), were analyzed alongside data from semiautomated segmentation reports. P <.05 was considered significant.

Results: The study included 45 fractures (23 zone 1 and 2, 22 zone 3) and 19 controls. Zone 3 fractures showed a significant association with higher body mass index (P < .01), hindfoot varus (P < .01), and metatarsus adductus (P < .01) compared with zone 1 and 2 fractures, and they more frequently had a nontraumatic origin (P < .01). Zone 3 fractures also showed a significantly higher transverse arch (P < .01). No differences have been observed between zone 1 and 2 fractures and the controls. Fractures with atraumatic origin were significantly associated with hindfoot varus (P < .01), metatarsus adductus (P < .01), hindfoot varus (P < .01), and metatarsus adductus (P < .01).

Conclusion: Hindfoot varus, metatarsus adductus, and a high transverse arch were significantly associated with zone 3 fractures as well as fractures with atraumatic origin.
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NewsBot · Jun 24, 2025

Strategies for managing fifth metatarsal base fractures
Mila Scheinberg , Matthew McCrosson, Shrey Nihalani, Matthew T Yeager, Marc Bernstein, Rajkumar Selvanayagam, Ashish Shah
JAAPA. 2025 Jul 1;38(7):40-44.

Fifth metatarsal base (FMB) fractures are among the most common fractures of the foot. Time to healing and time to return to activity depend on the location of the fracture, the presence of certain features or complications, and use of conservative or surgical management. This article provides a comprehensive overview of FMB fractures, including their classification by location or zone, diagnosis, and management based on fracture characteristics and complications. It emphasizes the role of advanced practice providers in recognizing cases requiring surgical intervention, and it provides management recommendations based on the current evidence base and the authors' practice experience to ensure optimal patient healing.
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Proximal fifth metatarsal fractures

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Transverse fracture proximal to the fifth metatarsal

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Proximal influences on plantar pressures

Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix

Proximal Plantar Intrinsic Tendinopathy

Proximal tibial bone graft

Does ‘proximal control’ need a new definition or a paradigm shift in exercise prescription?

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Proximal fifth metatarsal fractures

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Transverse fracture proximal to the fifth metatarsal

'MoAkin' biplanar proximal phalanx closing wedge osteotomy

Proximal influences on plantar pressures

Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix

Proximal Plantar Intrinsic Tendinopathy

Proximal tibial bone graft

Does ‘proximal control’ need a new definition or a paradigm shift in exercise prescription?

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