Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review

Abstract

Background: As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose: To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results: A total of 12 studies met inclusion and exclusion criteria, comprising 280 fifth metatarsal fractures treated surgically. Intramedullary screw fixation was the most common fixation construct (47.9%), and some form of intraoperative adjunctive treatment (calcaneal autograft, iliac crest bone graft, bone marrow aspirate concentrate, demineralized bone matrix) was used in 67% of cases. Radiographic union was achieved in 96.7% of fractures regardless of surgical construct used. The overall mean time to union was 9.19 weeks, with RTP at a mean of 11.15 weeks. The overall reported complication rate was 22.5%, with varying severity of complications. Refracture rates were comparable between the different surgical constructs used, and the overall refracture rate was 8.6%. Conclusion: Elite athletes appeared to have a high rate of union and reliably returned to the same level of competition after surgical management of fifth metatarsal fractures, irrespective of surgical construct used. Despite this, the overall complication rate was >20%. Specific recommendations for optimal surgical management could not be made based on the heterogeneity of the included studies.

Auditing the Representation of Female Athletes in Sports Medicine Research: Fifth-Metatarsal Fractures

“…5 Our audit showed greater disparity with female representation, with only 20.97% of patients suffering confirmed fifth-metatarsal fractures. Although this is greater than the 3.57% reported by Goodloe et al, 13 it is below the 26.05% female representation rate reported by Roche and Calder 40 regarding fifth-metatarsal fracture. All studies differentiated sex of patients, yet many failed to differentiate DUR, RFR, and NUR regarding sex.…”

“…10 In a recent systematic review of surgical management of proximal fifth-metatarsal base fractures in elite athletes, a total of 280 patients was found, with only 10 females reported for a representation of 3.57%. 13 Another systematic review performed by Roche and Calder 40 had higher female representation of 154 females of 591 patients, with a representation of 26.05%. Without proper female representation within fifth-metatarsal fracture research, conclusions must be drawn from their male counterparts, which is problematic given sexual dimorphisms and event-specific demands such as sport or training.…”

Jones Fracture in the National Football League

“…Additional orthobiologics used as conservative treatments such as PRP should also be explored for NFL athletes, as they have shown to allow return to training in 43–50 days in case series from other professional sports leagues [ 28 ]. The utility of other bone autografts aside from the iliac crest may also be an area of study, as calcaneal autografts have shown to be the most popular for other elite athlete populations [ 10 ].…”

“…The general consensus approach to Jones fracture in high-level athletes is surgical treatment with intramedullary (IM) screw fixation [ 10 ]. Despite this, non-operative approaches have been described as well [ 11 ].…”

Anatomical Features of Proximal Fifth Metatarsal Fracture: A Radiographic Study

“…We will also describe the incidence of different zones of proximal fth metatarsal fractures to provide some data. And the fth metatarsal proximal fractures are more commonly studied in athletes, 5,18,20 so this paper focuses on non-athletes to help ordinary people recover foot function as soon as possible. With the gathering and analysis of foot-related data, the occurrence of fth metatarsal base fractures in patients is further minimized or treated in this article.…”