Immediate weight-bearing for treatment of fractures at the base of the fifth metatarsal

Abstract

Objective: To determine the percentage of fractures of zones I, II and III; evaluate the influence of complete and immediate support at clinical and radiographic consolidation of these fractures; compare times to clinical and radiographic healing of fractures of zone III treated with plaster cast or dynamic fixation and immediate support, and evaluate results of treatment using the standardized protocol based on American Orthopaedic Foot and Ankle Society (AOFAS) criteria and compare them with reports in the literature. Methods: From January 2010 to July 2012, 111 patients were treated. Of these, 64 were women and 47 were men, the mean patient age was 36 years. The fractures were divided into zones I, II and III and treated with a plaster cast for immediate support with different immobilization times (3, 4 and 6 weeks, for each zone). The fractures of zone III (athletes and non-athletes whose fractures did not consolidate until the sixth week) were surgically treated with tension band and immediate support. Results: Fractures of zone I showed clinical and radiological healing at 3.1 and 7.5 weeks respectively. Fractures of zone II showed clinical and radiological healing at 4.1 and 8.7 weeks, respectively. Fractures of zone III treated with conservative approach had clinical and radiological healing at 6.3 and 10.1 weeks, respectively. Fractures of zone III that were surgically treated showed clinical and radiological healing at 6 and 9.5 weeks, respectively. Conclusion: Most fractures were from zone I. Incidence rates of fractures of zones I,II and III were 58%, 21% and 21%, respectively. Immediate support did not change the progress of fractures from the base of the fifth metatarsal, and all fractures consolidated at a time similar to that reported in the literature. Fracture of zone III treated with tension band and immediate support did not require more time for consolidation. Numbers of final evaluation with AOFAS criteria confirmed the efficiency of the standardized treatment protocol. High satisfaction with immediate support supports the improved quality of life during treatment.