5th Metatarsal Fx

Stress Fracture:

•  Fx distal to the ligaments which firmly bind the 4th and 5th metatarsals together

•  May be symptomatic before radiographic evidence of fx

•  Atheletic pt may benefit from ORIF  (closed treatment rate of non union is 50%)

•  If non union has developed, cast immobilization is unlikely to be successful -- consider bone-grafting & internal fixation w/ compression screw

Jones Fracture:

•  Fx at base of fifth MT at metaphyseal-diaphyseal junction

•, Extends into the 4-5 intermetatarsal facet. 

•  Located w/in 1.5 cm distal to tuberosity of 5th metatarsal

  Non Operative Treatment:  reserved only for acute fxs (in most cases);

•  Minimally displaced, < 3 months old, no evidence of non-union 

•  Up to 2/3 of these fractures should heal

•  Non-wt-bearing cast for 6-8 wks is necessary for healing;

•  Surgical Treatment: not meeting above criteria

Avulsion Fracture:

•  Extends to the metatarsal cuboid joint or proximal

•  Most common fr of the base of the 5th MT (over 90%);

•  May be due to pull of the lateral cord of the plantar aponeurosis

  Operative Treatment indicated only for displaced or very large avulsion fx, which extend into the cuboid-metatarsal joints;