Abstract
Introduction: Fractures of the tuberosity heal well irrespective of the treatment instituted. Fractures distal to the tuberosity have a high incidence of delayed union and non-union. This could be due to disruption of the vascular supply that enters the bone at the metaphyseal-diaphyseal region. It has also been reported that in these injuries, stress fractures occur at a different anatomic site that is more distal to acute fractures.
We present one of the largest reported series of such fractures in which we have explored the above statements.
Materials & Methods: A retrospective review of 300 closed fractures of the base of the fifth metatarsal- 268 were tuberosity fractures (group 1) and 32 were fractures distal to the tuberosity (group 2).
The patients were followed up in the outpatients clinic for a mean period of 2 months (group 1) and 16 months (group 2).
The distance of the fracture site from the proximal tip of the metatarsal was measured on the radiographs.
Results:
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All group 1 fractures healed well following symptomatic management and none required surgical intervention.
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Acute fractures in group 2 did better with non-weight bearing mobilization. Stress related fractures in group 2 took longer to heal when managed non-operatively.
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In group 2 patients, the difference in the site of acute & stress fractures was not statistically significant.
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No statistically significant correlation between distance from the proximal tip of the fifth metatarsal to the fracture site and union.
Conclusion:
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A standardized classification is important because there is great variability in the types of fractures and appropriate treatment.
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Nonunion in fractures distal to the tuberosity is not related to the distance of the fracture from the metaphyseal-diaphyseal region
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Acute and stress fractures distal to the tuberosity do not occur at different anatomic sites.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
