Stress fracture of the fifth metatarsal in athletes

Between 1975 and 1984 11 athletes with stress fractures of the fifth metatarsal were treated. There were 6 diaphyseal fractures, all of them in runners, and 5 transverse fractures of the base (Jones' fractures). The diaphyseal fractures healed with rest in 3-4 weeks. One patient with Jones' fracture was treated conservatively with a non-weight-bearing toe-to-knee plaster with good results. Four patients with delayed unions were treated operatively, three with a tension band and two Kirschnerwires, one with drilling and a single, thick Kirschner-wire. The fractures treated operatively progressed to bony union in about 3 months. The tendency of the Jones' fracture to delayed union and non-union in active athletes makes special requirements to the initial therapy of stress fractures. Best results have been obtained with a toe-to-knee cast with non-weight-bearing for 6-7 weeks. In delayed unions we recommend a tension band fixation with two Kirschner-wires. Non-unions should be treated with curettage and bone-grafting.