Zone 2 5th Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively

Abstract

OBJECTIVES: To quantify the rate of union and time to clinical and radiographic healing in Zone 2 proximal 5th metatarsal (MT) fractures and compare these outcomes between Zone 2 fractures treated operatively and nonoperatively. METHODS: Design: Retrospective cohort study Setting: Academic Level I Trauma Center Patient Selection Criteria: Patients with 5th metatarsal fractures who presented between December 2012 and April 2022 and confirmed to have Zone 2 fractures (defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view) were included in the study analysis in either the operative or nonoperative cohort. Outcome Measures and Comparisons: Nonunion, time to clinical healing by, and time to radiographic healing between operative and nonoperative treatment RESULTS: Among the 499 included patients, 475 patients (95.2%) were initially treated nonoperatively, and 24 patients (4.8%) were treated operatively. Both groups were similar in demographics (Table 1). There was no difference in the proportion of patients with nonunions between groups (6.1% in the nonoperative group versus 3.8% in the operative group, p = 1.000). Additionally, there was no statistically significant difference between groups with respect to the time to clinical healing by (9.9 +/- 8.3 weeks for the nonoperative group versus 15.4 +/- 15.0 weeks for the operative group, p = 0.117) or the time to radiographic healing by (18.7 +/- 12 weeks for the nonoperative group versus 18.5 +/- 16.6 weeks for the operative group, p = 0.970) (Table 2). CONCLUSIONS: Zone 2 5th metatarsal base fractures were successfully treated with nonoperative management. There was no evidence in this study that operative treatment leads to significantly faster clinical or radiographic healing.