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Fractures of the 5th Metatarsal Bone

By Danielle Campagne, MD , Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Fractures of the 5th metatarsal may occur in the base or shaft (diaphysis). Fractures of the diaphysis can be acute or stress fractures. Because these fractures have very different treatments and prognoses, accurate diagnosis is important. Diagnosis is with x-rays. Treatment depends on the location of the fracture.

Pain, swelling, and tenderness are usually well-localized to the fracture site.

Diagnosis of the 5th metatarsal is based on anteroposterior, lateral, and oblique foot x-rays.

Fractures of the 5th metatarsal diaphysis

Fractures of the 5th metatarsal diaphysis can be acute fractures or stress fractures. Acute diaphyseal fractures tend to occur near the metaphysis and are sometimes called Jones fractures.

Because the blood supply may be disrupted, nonunion and delayed union can result.

Treatment

  • Casting with no weight bearing

  • Orthopedic consultation

Treatment of 5th metatarsal diaphyseal fractures involves a 3-sided short leg cast with no weight bearing for 6 wk; patients are referred to an orthopedic surgeon to determine whether open reduction with internal fixation (ORIF) should be done.

Fractures of the 5th metatarsal base

Fractures of the base are sometimes called dancer's or pseudo-Jones fractures. The mechanism is usually a crush injury or an inversion force that causes avulsion by the peroneus brevis tendon. These fractures are more common than acute diaphyseal fractures (Jones fractures).

Because the base, unlike the diaphysis, has abundant collateral circulation, delayed union and nonunion are rare.

Treatment

  • Symptomatic

Treatment of 5th metatarsal base fractures is symptomatic and may include a hard-soled shoe or walking boot and weight bearing as tolerated.

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