Nonunion of fourth metatarsal base stress fracture in athletes treated with locking plate fixation and iliac bone grafting: A three-case report

Fourth metatarsal base stress fractures have been reported to cause complications, such as a substantial rate of delayed union and nonunion when treated nonoperatively. This report details three cases of nonunion of basal stress fractures of the fourth metatarsal in athletes who were successfully treated with a combination of locking plate fixation and iliac bone grafting. Three male athletes presented with nonunion of fourth metatarsal base stress fracture and underwent surgical treatment. In all cases, the nonunion site was decorticated, and iliac cancellous bone was grafted to the nonunion site. The bone fragments were reduced in a correct bone alignment and fixed using a locking plate. All the athletes obtained bone union and returned to the original sport at 12 weeks postoperatively. Surgical treatment combining locking plate fixation and iliac bone grafting for nonunion of a fourth metatarsal base stress fracture in athletes produced satisfactory results.