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Avulsion Frx of Base of 5th Metatarsal

- Discussion:
    - the most common frx of the base of the 5th metatarsal (over 90%);
    - may be due to pull of the lateral cord of the plantar aponeurosis
    - most often this frx is extra-articular, w/ the frx lying proximal to the metatarsocuboid joint;
    - commonly seen in dancers;
    - frx may be associated w/ lateral malleolar frx;

- Radiographs:
    - frx lines tend to be oriented more transversely to the joint;
    - evidence of fracture healing lags behind radiographic union;

- Diff Dx:
    - Jones fracture:
    - Normal Apophysis:
          - usually present between the ages of 9 to 14 years;
          - apophyseal line runs parallel to shaft of metatarsal along its lateral-inferior margin of the tubercle;
          - it does not extend proximally into the joint;
    - Os peroneum:
          - ossicle in peroneus longus tendon where it is seen at the tip of the fifth metatarsal base;
          - is seen in 15% of population;

- Non Operative Treatment:
    - short leg wt bearing cast for 4-6 wks;
    - controversies:
          - some authors advocate by a hard sole cast shoe and some (Wiener, et al (1997)) advocate a soft dressing;
    - even if there is radiographic evidence of delayed union or non-union, the patient's symptoms are usually minimal;

- Operative Treatment:
    - indicated only for displaced or very large avulsion frx, which extend into the cuboid-metatarsal joints

Fractures of the fifth metatarsal. Analysis of a fracture registry.

Treatment of fractures of the fifth metatarsal: a prospective study.    

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