Skip to main content

Advertisement

SpringerLink
Log in

The outcome of proximal fifth metatarsal fractures: redefining treatment strategies

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

To optimize the treatment strategy and reduce treatment costs of proximal fifth metatarsal fractures, clinical and patient-reported outcome, and its determinants were addressed.

Methods

A retrospective adult cohort study including 152 proximal fifth metatarsal fractures: 121 nonoperatively and 31 operatively treated. In the operative group, 21 were zone 1 and 10 zone 2 fractures. Median follow-up was 37.5 (IQR 20.8–52.3) months with a minimal follow-up of 6 months. Twenty-three demographic, fracture, and treatment characteristics were assessed as well as the healthcare costs. Outcome was assessed using the patient files, anterior-posterior and oblique X-rays, foot function index (FFI), visual analog score (VAS), and SF-36 questionnaires.

Results

The median FFI, physical SF-36, and VAS scores did not significantly differ between nonoperatively and operatively treated patients. The FFI and physical SF-36 were predominantly affected by a history of mobility impairment and pre-existent cardiovascular diseases, whereas mental SF-36 correlated significantly with higher ASA-score. Overall complication rate was 5.9% (4.1 vs. 12.9%; p = 0.065, nonoperative vs. operative, respectively). Nonunion was recorded in only one (nonoperatively) treated patient. The total healthcare costs for operative treatment were 4.2 times higher compared to nonoperative treatment (€1960 vs. €463 per patient, respectively).

Conclusion

Overall, the clinical and patient-reported outcome was good. The foot function and quality of life were mainly affected by comorbidity, rather than fracture and treatment-related variables. Although nonoperatively treated patients indicated decreased mental quality of life, our study indicates that proximal fifth metatarsal fractures can safely be treated nonoperatively without the risk of nonunion, with fewer complications and lower healthcare costs.

Level of evidence

3.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ASA-score:

American Society of Anesthesiologists physical status score

BMI:

Body mass index

DVT:

Deep venous thrombosis

CVRF:

Cardiovascular risk factors

FFI:

Foot function index

SF-36:

Short form 36

VAS:

Visual analog scale

LOS:

Length of stay

IQR:

Interquartile range

References

  1. Brad A, et al. The epidemiology of metatarsal fractures. Foot Ankle Int. 2006;27(3):172–4.

    Article  Google Scholar 

  2. Owen RJ, FG Hickey, Finlay DB. A study of metatarsal fractures in children. Injury. 1995;26:537–8.

    Article  CAS  Google Scholar 

  3. Cakir H, et al. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg. 2011;131(2):241–5.

    Article  CAS  Google Scholar 

  4. Jones R. Fracture of the base of the fifth metatarsal bone by indirect violence. Ann Surg. 1902;35:697–700.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Lawrence SJ, Botte MJ. Jones fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993;14:358–65.

    Article  CAS  Google Scholar 

  6. Torg JS. Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics. 1990;13(7):731–7.

    CAS  PubMed  Google Scholar 

  7. McKeon KE, Johnson JE, McCormick JJ, Klein SE. The intraosseous and extraosseous vascular supply of the fifth metatarsal: implications for fifth metatarsal osteotomy. Foot Ankle Int. 2013;34(1):117–23.

    Article  Google Scholar 

  8. Smith JW, Arnocsky SP, Hersh A. The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing. Foot Ankle. 1992;13(3):143–52.

    Article  CAS  Google Scholar 

  9. Cheung CN, Lui TH. Proximal fifth metatarsal fractures: anatomy, classification, treatment and complications. Arch Trauma Res. 2016;5(4):e33298.

    Article  Google Scholar 

  10. Polzer H, Polzer S, Mutschler W, Prall WC. Acute fractures of the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury. 2012;43:1626–32.

    Article  Google Scholar 

  11. Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury. 2010;41:555–62.

    Article  CAS  Google Scholar 

  12. Konkel KF, et al. Nonoperative treatment of fifth metatarsal fractures in an Orthopaedic Suburban private multispecialty practice. Foot Ankle Int. 2005;26(9):704–7.

    Article  Google Scholar 

  13. Brinker MR. Nonunions evaluation and treatment. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, editors. Skeletal trauma: basic science, managment and reconstruction. 3rd ed. Philadelphia: Saunders; 2003. pp. 507–604.

    Google Scholar 

  14. Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P 3rd, Sprague S, Schemitsch EH. A lack of consensus in the assessment of fracture healing among orthopaedic surgeons. J Orthop Trauma. 2002;16:562–6.

    Article  Google Scholar 

  15. Smeets B, Nijs S, Nderlita M, Vandoren C, Hoekstra H. Health care usage and related costs in fibular plating for AO type 44-B ankle fractures in a Belgian University Hospital: an exploratory analysis. J Foot Ankle Surg. 2016;55:535–41.

    Article  Google Scholar 

  16. Verpleegdagprijzen ziekenhuizen. (n.d.). Retrieved from November 19, 2016. http://www.riziv.fgov.be/nl/themas/kost-terugbetaling/door-ziekenfonds/verzorging-ziekenhuizen/Paginas/verpleegdagprijzen-ziekenhuizen.aspx. Accessed 19 Nov 2016.

  17. Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol. 1991;44(6):561–70.

    Article  CAS  Google Scholar 

  18. Aaronson NK1, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51(11):1055–68.

    Article  CAS  Google Scholar 

  19. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Jt Surg. 1978;60(6):776–82.

    Article  CAS  Google Scholar 

  20. Gray AC, Rooney BP, Ingram R. A prospective comparison of two treatment options for tuberosity fractures of the proximal fifth metatarsal. Foot (Edinb). 2008;18:156–8.

    Article  Google Scholar 

  21. Gosele A, Schulenburg J, Ochsner PE. Early functional treatment of a 5th metatarsal fracture using an orthopedic boot. Swiss Surg. 1997;3:81–4.

    CAS  PubMed  Google Scholar 

  22. van Aaken J, et al. Symptomatic treatment of nondisplaced avulsion and Jones fractures of the fifth metatarsal: a prospective study. Rev Med Suisse. 2007;3:1792–4.

    PubMed  Google Scholar 

  23. Bigsby, et al. Functional outcome of fifth metatarsal fractures. Injury. 2014;45:2009–12.

    Article  CAS  Google Scholar 

  24. Egol K, et al. Avulsion fractures of the fifth metatarsal base: a prospective study. Foot Ankle Int. 2007;28:581–3.

    Article  Google Scholar 

  25. Mologne TS, Wright RW, Clapper MF, O’Brien TJ. Early screw fixation versus casting in the treatment of acute Jones fractures. Am J Sports Med. 2005;33:970–5.

    Article  Google Scholar 

  26. Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int. 1997;18:267–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    P. Monteban, S. Nijs & H. Hoekstra

  2. Faculty of Medicine, KU Leuven-University of Leuven, 3000, Leuven, Belgium

    J. van den Berg & J. van Hees

  3. Department of Development and Regeneration, KU Leuven-University of Leuven, 3000, Leuven, Belgium

    S. Nijs & H. Hoekstra

Authors
  1. P. Monteban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. van den Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. van Hees
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Nijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Hoekstra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Hoekstra.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants

None.

Informed consent

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monteban, P., van den Berg, J., van Hees, J. et al. The outcome of proximal fifth metatarsal fractures: redefining treatment strategies. Eur J Trauma Emerg Surg 44, 727–734 (2018). https://doi.org/10.1007/s00068-017-0863-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-017-0863-x

Keywords

Search

Navigation