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Risk Factors for Union Deformities in Fifth Metatarsal Fractures: A Scoping Review.

Date Van der Meij^1,2, Bradley Weaver¹, Alireza Ebrahimi¹

¹Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Foot & Ankle Specialist

|March 23, 2026

Summary

This summary is machine-generated.

Union deformities in fifth metatarsal (5MT) fractures are common. Key factors influencing healing include fracture zone, fixation method, and early activity, with bone grafting improving outcomes.

Keywords:

Jones fracture delayed union metatarsal fracture nonunion prediction stress fracture

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Area of Science:

Orthopedic Surgery
Podiatric Medicine
Sports Medicine

Background:

Proximal fifth metatarsal (5MT) fractures frequently result in union deformities after treatment.
Identifying risk factors is crucial for predicting and managing these fractures.

Purpose of the Study:

To systematically review and summarize the risk factors associated with delayed or nonunion in 5MT fractures.

Main Methods:

A comprehensive literature search was conducted across major medical databases.
Methodological quality was assessed using the MINORS tool.
Data on healing rates, complications, fracture characteristics, and treatment outcomes were extracted from 13 eligible studies.

Main Results:

Fracture zone (especially zone 2), plantar gap >1 mm, small screw diameter, and premature return to activity predict nonunion.
Surgical treatment accelerated union but increased risks of delayed union and refracture.
Bone grafting and larger screw diameters enhanced union rates.

Conclusions:

Fracture zone, chronicity, and fixation strategy significantly impact 5MT fracture healing and union deformities.
Risk stratification and tailored treatments can minimize nonunion and improve patient recovery.
Further high-quality research is needed for standardized definitions and protocols.