J Korean Orthop Assoc.  2021 Apr;56(2):150-156. 10.4055/jkoa.2021.56.2.150.

Outcome of Conservative Treatment of the Zone I, II 5th Metatarsal Base Fracture under Early Weight-Bearing

• Gwak HC
• Park DH
• Kim JH
• Lee CR
• Kwon YU
• Kim DS

• KMID: 2514861
• DOI: http://doi.org/10.4055/jkoa.2021.56.2.150

Abstract

Purpose
To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment.
Materials and Methods
From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6–15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work.
Results
Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up.
Conclusion
Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

Keyword

fracture; 5th metatarsal base; early weight-bearing