Fractures of the fifth metatarsal base

Abstract

Fractures of the fifth metatarsal base are among the most common fractures of the foot. They are typically caused by indirect violence during sports activities. This region is also a site where stress fractures occur frequently. Diagnosis is based on the patient’s medical history, clinical examination and imaging methods. The fundamental imaging method is radiography of the foot in three views. MRI is used primarily for early diagnosis of stress fractures. CT examination is beneficial mainly in complex foot injuries,
in order to rule out associated fractures.
Several classifications of fractures of the fifth metatarsal base have been published in the last 50 years, categorizing these fractures in terms of their location, appearance of the fracture line, type of treatment, healing and complications. Currently, the most frequently used one is the classification developed by Lawrence and Botte.
Non-operative treatment is indicated in undisplaced or minimally displaced fractures, fractures in elderly patients and in patients contraindicated for surgery. The method of choice in undisplaced fractures is the Barouk boot with partial weight-bearing as tolerated by the patient, while displaced fractures up to 2 mm are fixed in a low plaster cast (Essex-Lopresti shoe).
Operative treatment is indicated in fractures displaced by more than 2 mm or involving more than 30% of the articular surface of the cuboid-metatarsal joint. Internal fixation is most commonly performed with the use of intramedullary screw, tension wire band, K-wires or plates. Stress fractures are preferably treated by surgery to reduce the risk of non-union, delayed healing and the risk of refractures.
The most common complications associated with treatment of fractures of the fifth metatarsal base include delayed healing, non-union development, refractures and patient discomfort.