Between 1973 and 1982 46 fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of 40 months (range, 6 to 108 months). Roentgenographic criteria were used to define 3 types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the 25 acute fractures in this series, 15 were treated with a non-weight-bearing toe-to-knee cast, and 14 of them healed in a mean of 7 weeks. Only 4 of the other 10, which were treated with various weight-bearing methods, progressed to union. Of the 12 patients with delayed union, one refused treatment, one was treated with a bone graft, and 10 were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these 10 fractures, 7 healed in a mean of 15.1 months and 3 eventually required grafting for non-union. Of the 9 non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, 8 healed in a mean of 3 months. In all, 20 fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these 20 fractures, 19 progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)
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Between 1973 and 1982 46 fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of 40 months (range, 6 to 108 months). Roentgenographic criteria were used to define 3 types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the 25 acute fractures in this series, 15 were treated with a non-weight-bearing toe-to-knee cast, and 14 of them healed in a mean of 7 weeks. Only 4 of the other 10, which were treated with various weight-bearing methods, progressed to union. Of the 12 patients with delayed union, one refused treatment, one was treated with a bone graft, and 10 were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these 10 fractures, 7 healed in a mean of 15.1 months and 3 eventually required grafting for non-union. Of the 9 non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, 8 healed in a mean of 3 months. In all, 20 fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these 20 fractures, 19 progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)
Copyright remains with the authors and publisher.