Review Question - QID 3463

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5th Metatarsal Base Fracture TREATMENT Operative QID: 3463 (OBQ11.40)

QID 3463 (Type "3463" in App Search)

A 23-year-old professional lacrosse player injures her left foot while walking down a flight of stairs. She has pain and inability to bear weight on her injured foot. She has no plantar ecchymosis but does have tenderness over her lateral foot. A radiograph of her foot is found in Figure A. What is the best form of management?

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Hard-soled shoe

90/4461

Cast immobilization

254/4461

Modified Brostrom procedure

16/4461

Intramedullary screw fixation

91%

4053/4461

Operative repair of the Lisfranc fracture

26/4461

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The clinical scenario and radiographs are consistent with a fracture of the base of the fifth metatarsal. In young athletes, operative screw fixation is the treatment of choice. The 5th metatarsal is divided into 3 zones. Zone I is an avulsion fracture, zone II is described as a Jones fracture and zone III is proximal diaphyseal fracture (Illustration A). Nonunions are more common with fractures in zones II and III.

Lehman et al reviewed fractures of the base of the fifth metatarsal. They describe the current controversies regarding nomenclature and treatment. They recommend NWB immobilization for acute fractures and delayed unions. The active patient and non-unions are treated operatively.

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