Review Question - QID 1097

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5th Metatarsal Base Fracture TREATMENT Operative QID: 1097 (OBQ05.211)

QID 1097 (Type "1097" in App Search)

A 25-year-old professional basketball player sustains a twisting injury to his foot. He complains of immediate pain and is unable to finish the game. Two days following the injury, he has continued tenderness with palpation of the base of the 5th metatarsal. A radiograph is provided in Figure A. Which of the following would most likely lead to the quickest return to play?

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Protected weightbearing in a short leg cast with gradual return to sport

71/1709

Intramedullary screw fixation

89%

1528/1709

MRI evaluation

19/1709

Foot and ankle taping with immediate return to sport

7/1709

Open reduction internal fixation with a precontoured plate

73/1709

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The fifth metatarsal base fracture that occurs at the metaphyseal-diaphyseal junction should be treated with placement of an intramedullary screw for high performance athletes, which allows for quicker return to play and time to union.

Type II, fifth metatarsal base fractures (Jones Fracture) occur at the metaphyseal-diaphyseal junction approximately 2.5 cm distal to the base. The acute Jones fracture can also be treated with a non-weight bearing cast for 6-8 weeks in patients that are not athletes. This is a circulatory watershed region that is subject to nonunion secondary to poor blood supply. Clinically, failure of fixation has been noted in athletes who returned to full activities before radiographic evidence of complete radiographic union.

Portland et al performed a Level 4 study of 22 patients that underwent intramedullary screw fixation for 5th metatarsal fractures. They report 100% rate of union and 9% incidence of complications