Fifth metatarsal fractures. Biomechanics, classification, and treatment.

Fractures of the fifth metatarsal are treated conceptually based on anatomic location and character of the fracture site. Intra-articular disruptions require reconstruction, if possible. Malalignment of acute fractures requires either closed reduction or open reduction if the malalignment represents a load-bearing dysfunction to the forefoot. Segmental defects require bone grafting and stabilization with plate and screws. Jones fracture is most effectively managed with medullary lag screw delivery in the active or athletic patient. Casting can be considered for high-risk patients. Late bone grafting for sclerotic nonunion is necessary with inlaid grafts harvested from the calcaneus or tibia. Tuberosity fractures require open reduction only when articular involvement is a problem or when distraction is apparent. Otherwise, they can be expected to heal rapidly without long-term problems.