$5th metatarsal fracture classification$

Acute fractures treated non-operatively had a union rate of 76% compared to 96% in fractures treated with a screw.

$5th metatarsal fracture classification$

Return to sports after intramedullary screw fixation for acute fractures ranged from 4 to 18 weeks. For the cast group, the median times were 14.5 and 15.0 weeks, respectively.Ī meta-analysis performed by Roche and Calder examined various treatment options and outcomes after acute fractures, delayed unions, and non-unions, including 26 studies (22 level IV, 1 RCT). For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. Only one of 19 patients in the surgery group was considered a treatment failure. Eight of 18 (44%) in the cast group were considered treatment failures with 5 non-unions, 1 delayed union, and 2 re-fractures. Mologne and colleagues reported the outcomes of screw fixation versus casting for acute Jones fractures in an RCT (18 casts vs 19 screw fixations) with a mean follow-up of 25.3 months. Only two patients failed to their previous level of sports, and one delayed union and re-fracture occurred. Radiographic union occurred at a mean of 5 weeks.

$5th metatarsal fracture classification$

Murawski and Kennedy reported on 26 patients who underwent intramedullary fixation. Fixation is most commonly performed using an intramedullary compression screw (solid or cannulated, partially-threaded). Surgery is considered for displaced fractures, symptomatic non-unions, and for patients who require earlier weight bearing (high-level athletes, other occupational needs). In the majority of cases, undisplaced or minimally displaced fractures are treated for 6 weeks in a nonweight-bearing cast followed by a progressive increase in weight bearing in a walker boot for further 2 weeks. A single nutrient artery feeding the fifth metatarsal shaft enters the medial cortex near the junction of the proximal and middle third of the diaphysis resulting in a watershed area near the proximal metadiaphyseal junction. These fractures occur in an area of relative hypovascularity, increasing the chance of delayed union or non-union. If indicated, surgery can be considered in symptomatic cases and the options include excision or fixation depending on the size of the fragment.įirst described by Sir Robert Jones (1902), usually results from adduction and axial loading of a plantarflexed foot. Asymptomatic non-union may be slightly more common but does not necessarily require any treatment. Symptomatic non-union is very rare with these fractures. However, radiographic evidence for union may lag behind resolution of clinical symptoms. Regardless of any specific treatment modality, majority of these fractures heal uneventfully within 6 to 8 weeks. A comparative cohort study of 39 patients (23 casts, 16 removable boots) showed a shorter mean time to preinjury function and less pain with boots compared to cast. Some studies have reported successful outcomes with a removable cast. An RCT including 60 avulsion fractures reported that patients treated with a soft dressing recovered significantly faster than those treated in a cast (33 days vs 46 days). Type III: non-unions with obliteration of the intramedullary canalĬonservative treatment ranges from a soft bandage to a light weight cast.

$5th metatarsal fracture classification$

Type II: delayed fracture healing with a widened fracture line and intramedullary sclerosis Type I: acute fractures without intramedullary sclerosis Torg and colleagues defined three categories of fifth metatarsal base fractures based on healing potential and radiographic appearance: Type IIIB: intra-articular tuberosity avulsions Type IIIA: extra-articular tuberosity avulsions Type II: chronic metadiaphyseal fractures with either a clinical symptoms or radiologic evidence of stress reaction Type IB: acute, comminuted metadiaphyseal fractures Type IA: acute, undisplaced, metadiaphyseal fractures Zone III - the proximal diaphyseal region - stress fracture.ĭeLee and colleagues separated proximal fifth metatarsal fractures into:

$5th metatarsal fracture classification$

Zone II - the metadiaphyseal region - Jones fracture (at the level of 4th/5th intermetatarsal joint) Zone I - the tuberosity - avulsion fracture (more than 90% fractures in their study) Lawrence and Botte divided the proximal fifth metatarsal into three distinct fracture zones: Fractures at the junction of metaphysis and diaphysisĪlthough commonly used, this categorization carries some ambiguity because the precise anatomic location of the physeal junctions is not well defined. Fifth metatarsal fractures have been classically categorized based on location:Ģ.

$5th metatarsal fracture classification$