Fifth Metatarsal Fractures: Time to Discharge

Research Type: Level 4 – Case series Introduction/Purpose: Fifth metatarsal fractures are common injuries. There is current disagreement on the preferred treatment, with certain fracture types. The aim of this study was to investigate time to discharge across all 5th metatarsal fracture and their respective fracture mapping patterns. Methods: A historic cohort study was performed of all fifth metatarsal fractures presenting to our unit between February 2016 - July 2021 was performed. Date of injury, fracture morphology and zones involved, clinical and radiographic follow up as well as surgical interventions were collected. Results: 1331 fractures were included in this study. The fracture pattern with the longest time before discharge was a fracture spanning zones 2-3 (mean 11.40, 95% CI 5.65, 17.15), followed by a fracture limited to zone 3 (mean 9.72, 95% CI 1.14, 7.31). Both fractures patterns had significantly longer times to discharge than zone 1 (p <.001), zone 1-2 (p <.001), zone 2 (p <.001), zone 2-shaft (p=.001), zone 3-shaft (p=.004) and shaft fractures (p <.001). Fractures spanning zone 2-3 and zone 3 were the highest to undergo surgery (11.63% and 9.09% respectively) which was significantly greater than other fracture types (p=.003). The average time to surgery was 21.85 weeks (95% CI 8.87, 34.82), with the average time to discharge post-surgery of 8.07 weeks (95% CI 5.08, 11.07). Conclusion: Fractures spanning zone 2-3 (typical Jones) and zone 3 fractures have the highest time to discharge and highest rate of surgery. Time to surgery is low, in keeping with surgery proceeding not typically for chronic non unions but for more acute presentations. All fractures undergoing surgery united, with only short follow up required post-surgery.