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Review
. 2016 Jun 13;5(4):e33298.
doi: 10.5812/atr.33298. eCollection 2016 Dec.

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Chi Nok Cheung  1 , Tun Hing Lui  1
Affiliations
Review

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Chi Nok Cheung et al. Arch Trauma Res. .

Abstract

Context: Fractures of proximal fifth metatarsal are one of the most common fractures of the foot.

Evidence acquisition: A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.

Results: The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.

Conclusions: Lawrence and Botte's classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

Keywords: Anatomy; Bone; Classification; Evidence-Based Medicine; Fracture Fixation; Fractures; Metatarsal Bones.

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Figures

Figure 1.
Figure 1.. Lawrence and Botte’s Classification of Proximal Fifth Metatarsal Fractures (Zone 1, 2 and 3)
Figure 2.
Figure 2.. A case of Proximal Fifth Metatarsal Fracture With Missed Lisfranc Injury That Resulted In Nonunion of the Fracture and Degeneration of the Lisfranc Joint
Figure 3.
Figure 3.. A Case of Lawrence and Botte Zone 1 Fracture That Was Treated Conservatively With Rocker Boot
A, injury film showing non-displaced fracture. B, radiograph taken six weeks after the injury, showing fracture displacement. C, radiograph taken nine months after the injury showing that the fracture had healed.
Figure 4.
Figure 4.. A Case of Lawrence and Botte Zone 3 Fracture Treated Conservatively With a Cast
A, injury film. B, radiograph taken nine weeks after the injury showed that the fracture healed with residual lateral cortical notch. The notch is a common radiographic appearance after the fracture heals. It takes a long time to disappear. C, radiograph taken 15 months after the injury, showed the notch disappeared.
See this image and copyright information in PMC

References

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    1. Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int. 2006;27(3):172–4. - PubMed
    1. Jones R. I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann Surg. 1902;35(6):697–700 2. - PMC - PubMed
    1. Josefsson PO, Karlsson M, Redlund-Johnell I, Wendeberg B. Closed treatment of Jones fracture. Good results in 40 cases after 11-26 years. Acta Orthop Scand. 1994;65(5):545–7. - PubMed
    1. Dameron TB. Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. J Am Acad Orthop Surg. 1995;3(2):110–4. - PubMed

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