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Stress Fractures of the Fifth Metatarsal

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Stress Fractures in Athletes

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Abstract

Stress fractures of the fifth metatarsal are common injuries in athletes. They are high-risk stress fractures that frequently require surgery. These fractures have a unique classification system, and treatment options are largely dependent on classification as well as patient characteristics. The risk of delayed union and nonunion in these fractures is high if misdiagnosed or treated improperly.

The location and blood supply to the fifth metatarsal contribute to its vulnerability to stress injury. The metaphyseal–diaphyseal junction is located at a vascular watershed area, which may potentially limit its healing potential. The stiff ligamentous attachments on the proximal end of the bone create a high-stress area at this same metaphyseal–diaphyseal junction. The combination of poor blood supply and biomechanical factors make this fracture difficult to treat and prone to delayed union, nonunion, and refracture.

In high-level athletes, surgical fixation is commonly required to adequately treat these fractures. An intramedullary screw is the typical implant of choice and has a high success rate for healing. Nonoperative treatment has limited utility in these fractures but may be employed if the diagnosis is made early. Even with appropriate fixation, the refracture rate can reach just over 10 %, highlighting the need for complete radiographic healing and appropriate postoperative rehabilitation prior to return to sport.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA

    Amanda Weller MD

  2. Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA, 15203, USA

    Christopher D. Harner MD

  3. Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 5200 Centre Avenue, Pittsburgh, PA, 15232, USA

    MaCalus V. Hogan MD

Authors
  1. Amanda Weller MD
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  2. Christopher D. Harner MD
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  3. MaCalus V. Hogan MD
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Corresponding author

Correspondence to Christopher D. Harner MD .

Editor information

Editors and Affiliations

  1. Assistant Professor, Department of Orthopedics, Team Physician, Department of Athletics, Physician Lead, Endurance Medicine, Sports Medicine Center, The Ohio State University, Columbus, Ohio, USA

    Timothy L. Miller

  2. Judson Wilson Professor, Department of Orthopedics, Head Team Physician, Department of Athletics, Executive Director, Sports Medicine Center, The Ohio State University, Columbus, Ohio, USA

    Christopher C. Kaeding

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© 2015 Springer International Publishing Switzerland

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Weller, A., Harner, C.D., Hogan, M.V. (2015). Stress Fractures of the Fifth Metatarsal. In: Miller, T., Kaeding, C. (eds) Stress Fractures in Athletes. Springer, Cham. https://doi.org/10.1007/978-3-319-09238-6_11

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  • DOI: https://doi.org/10.1007/978-3-319-09238-6_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09237-9

  • Online ISBN: 978-3-319-09238-6

  • eBook Packages: MedicineMedicine (R0)

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