Traumatic Lesser Metatarsal Fractures: A Case Series and Review of the Literature

Abstract

Background: metatarsal fractures are a commonly encountered musculoskeletal injury. Scant literature exists to support current treatment guidelines and few studies describe the functional or occupational outcomes of patients with lesser metatarsal fractures. The purpose of this study is to describe occupational outcomes for traumatic lesser metatarsal fractures in relation to current treatment guidelines. Methods: a retrospective review of metatarsal fractures in adult military patients 18 years and older was performed. Data included: patient demographics, fracture angulation and displacement, treatment modality, associated injuries, rate of return to active duty, requirement for additional surgeries, ability to run a 2-mile physical fitness test, and presence of permanent activity limitations. Treatment guideline criteria were applied and compared with the occupational outcomes measured. Results: 38 fractures were included. The mean age was 27.2 ± 7.8 (19–48). Here, 28 fractures were initially treated non-operatively. Fractures selected for non-operative treatment had a mean displacement of 1.7 +/− 1.1 mm and a mean angulation of 3.3 +/− 3.5° at initial presentation. Fractures selected for operative treatment had a mean displacement of 4.5 +/− 2.4 mm and a mean angulation of 15.7 +/− 13.8° at initial presentation. The return to run rate was 89% in non-operatively treated patients and 50% in operatively treated patients (p = 0.02). Non-operative patients returned to running at a mean of 119 +/− 103 days and operative patients returned to running at a mean of 306 +/− 191 days (p = 0.0039). 50% of operatively treated patients and 11% of non-operatively treated patents were unable to remain in the military due to their metatarsal fractures. Conclusions: patients treated non-operatively were more likely to return to running and returned to running sooner than operatively treated patients. Current treatment guidelines could not be supported or refuted based upon the study results. The occupational and functional outcomes demonstrated in this study may assist surgeons in counseling patients on their planned treatment and anticipated recovery following a lesser metatarsal fracture.