Review Question - QID 217473

A spiral diaphyseal fracture of the fifth metatarsal is likely to be successfully managed nonoperatively with a rigid sole shoe and weight-bearing.

Metatarsal fractures are among the most common injuries of the foot that may occur due to trauma or repetitive microstress. Diagnosis is made with plain radiographs of the foot. Treatment may be nonoperative or operative depending on the specific metatarsal involved, the number of metatarsals involved, and fracture displacement. Diaphyseal fifth metatarsal fracture, also known as a dancer's fracture, has been shown to be successfully managed nonoperatively in most cases as they have high union rates and low rates of associated morbidity. Treatment for these fractures is usually a hard-soled shoe and symptomatic management.

Aynardi et al. reviewed the incidence and long-term outcome of nonoperative management for displaced oblique spiral fractures of the fifth metatarsal shaft. They reported that of 142 acute fractures that were managed nonoperatively, there were 2 delayed unions, 1 asymptomatic nonunion treated nonoperatively, and 2 painful nonunions that required open reduction internal fixation with bone grafting. They concluded that nonoperative management of these fractures resulted in excellent, long-term functional outcomes.

Morgan et al. retrospectively reviewed the functional outcomes of spiral diaphyseal fractures of the fifth metatarsal that are treated with non-operative management. They reported that patients managed in a shoe had a statistically significant shorter average time to return to pain-free walking (4.6 vs 8.4 weeks, p=0.027) and average time to return to normal footwear (6 vs 7.3 weeks, p=0.044) in comparison to a boot. They concluded that all patients in this series were treated without surgery regardless of the degree of displacement and had excellent outcomes.

Incorrect Answers:
Answer 1: First metatarsal fracture with any displacement is an operative indication. These fractures have no intermetatarsal ligament support. The first metatarsal provides approximately 30-50% of weight bearing with gait
Answers 2&3: The central metatarsals (2-4) that have a sagittal plane deformity >10 degrees or >4mm of translation should be considered for operative intervention
Answer 5: Multiple metatarsal fractures is an indication for operative intervention by either percutaneous vs open reduction and fixation