Fifth Metatarsal Fracture–A Systematic Review of the Treatment of Fractures of the Base of the Fifth Metatarsal Bone

Abstract

Background: Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. Nevertheless, no evidence-based treatment recommendations are available to date.

Methods: The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones; zone II, in the area of the joint; zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture.

Results: Nine studies compared different treatments of zone I fractures. Two of these were randomized controlled trials (RCTs); in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. 28 days; p = 0.001), with otherwise similar outcomes. The non-randomized studies revealed a faster return to full function (33 vs. 46 days; p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.

Conclusion: Fractures in zones I and II should be treated with early functional therapy. There seems to be no reason to consider zone I and II fractures as two separate entities, as the outcomes in the two groups are similar. In contrast, fractures in zone III should primarily be treated surgically.

Figure 1

Retrospective analysis of the distribution of metatarsal fractures within the authors’ own patient population. Schematic diagram of the distribution of fractures (a) of the metatarsals, (b) within the 5th metatarsal bone (base, shaft, distal) and (c) within the base of the 5^th metatarsal (Lawrence and Botte three-zone classification [3])

Figure 2

Inconsistent use of the term “Jones-fracture” in the various classifications (Figure 2a) and a new proposal for a treatment-based classification (Figure 2b)

Figure 3

Flowchart of study selection using the PRISMA specifications (5)

eFigure

Flowchart showing patient selection process from the clinical and radiological databases for the acquisition of the frequency of metatarsal fractures Data collection was approved by the Ethics Committee of the LMU Hospital – Munich (# 20–442). MT, metatarsal; n, number