Fifth metatarsal fracture mapping and associated clinical outcomes

Fifth metatarsal fractures are among the most common foot injuries. Classification of these fractures are commonly used to guide treatment, however the reliability of classification systems are variable.

A historic cohort study of 2,165 patients with fifth metatarsal fractures managed at a Level 1 Major Trauma Centre between 2016 and 2023 was conducted. Fractures configurations were mapped to identify common patterns. Clinical outcomes including time to discharge (TTD), further clinic appointments (FCA), and operative intervention (OI) were assessed based on these common patterns.

Of the 2,165 patients, 60.4% were discharged directly from the Virtual Fracture Clinic (VFC) and only 1.3% required operative intervention. Delayed union rates requiring surgery were low, with Zone 3 fractures demonstrating the highest rate at 2.74%. With fractures spanning multiple zones exhibiting a shorter TTD compared to isolated Zone 2 or 3 fractures. One third (33.3%) of fractures spanned multiple zones (e.g. Zone 1-3).

Fifth metatarsal fractures have a low risk of delayed/non-union, irrespective of the zone of injury (ZOI). Current classification systems are incapable of guiding treatment due to their inability to accurately identify fractures that span multiple zones, with fracture mappings evidencing higher than reported variability in fracture configurations.

Level 3.