Surgical Management of Fifth Metatarsal Diaphyseal Fractures: A Retrospective Outcomes Study

Abstract

Fifth metatarsal diaphyseal fractures are a common injury treated by foot and ankle surgeons. The limited data on this specific fracture type has promoted nonoperative treatment with immobilization. The primary objective of the present study was to record the radiographic healing time of fifth metatarsal diaphyseal fractures after surgical intervention and present the specific fracture characteristics. The medical records of a series of 64 patients with surgically managed fifth metatarsal diaphyseal fractures were retrospectively reviewed. The data collected consisted of radiographic healing times, fracture characteristics, and patient demographics. The mean average age at injury was 49.23 ± 15.35 years with greatest incidence in females at 73.44%. The mean healing time was 7.73 ± 4.74 weeks, with an overall complication rate of 6.25%. The fractures were classified into 2 specific categories according to the anatomic location. Type I fractures occurred in a significantly older population, were significantly longer in length, and healed faster. The mean displacement and angulation at injury was 3.20 ± 1.22 mm, and 5.89° ± 4.60°, respectively, for all fractures. Of the 64 patients, 1 (1.56%) experienced nonunion, 2 (3.13%) delayed unions, and no malunions. One patient (1.56%) underwent repeat operation for hardware removal. One case (1.56%) of superficial postoperative infection developed and was treated with oral antibiotics. We observed good surgical outcomes with minimal postoperative complications. We also identified 2 specific entities of fifth metatarsal diaphyseal fractures. On the basis of our results, we advocate surgical intervention even for minimally displaced diaphyseal fractures to maintain even weightbearing across the metatarsal parabola.

Keywords: displaced fracture; fixation; healing time; malunion; metatarsalgia; nonunion.