Should You Opt for Surgery for a Fifth Metatarsal Fracture?

Fifth metatarsal fracture: to operate or not to operate?

Hello Dr.
Li, I had an accident on March 3rd that resulted in a fracture of the fifth metatarsal.
Since I am working in Japan and cannot return to Taiwan for an extended period, I sought treatment at a nearby hospital in Japan.
I understood about 80% of the doctor's diagnosis but couldn't grasp everything completely, so I would like to consult you for advice.

After an X-ray on March 5th, the first hospital recommended surgery, but since they were unable to perform the surgery, they referred me to another hospital.
The X-ray images at that time can be found here: https://imgur.com/a/jZdlp.
The second hospital conducted X-rays and a CT scan; the first image is the frontal view: https://imgur.com/a/dqJvO, and the second image is the dorsal view: https://imgur.com/a/D7oEd.
The doctor diagnosed that the outcome would be similar whether I had surgery or not, and it would take about four weeks to walk normally.
They mentioned that the lateral side of the bone at the lower end was too thin to insert a screw, and since surgery carries risks, they suggested monitoring the situation and returning for a follow-up next week to see if there was any displacement to decide on surgery.
During my follow-up on March 14th, the X-ray results showed no displacement.
The doctor again asked if I wanted to proceed with surgery, stating that while the surgical wound would heal more neatly, not having surgery would not lead to significantly worse outcomes due to a lack of relevant experience.
Being abroad, I couldn't find anyone to consult, so I decided against surgery.
The doctor advised me to return for a follow-up in two weeks.

I have a few questions I would like to ask you:
1.
In this situation, do you recommend surgery or natural healing? If I do not have surgery, will there be any long-term complications?
2.
The doctor mentioned that I could use crutches and walk on the inner side of my foot, but it is still somewhat swollen after two weeks, so I am hesitant to walk.
Is this a normal phenomenon?
3.
When I am able to walk, will soaking in a hot spring help speed up bone recovery, or could it have negative effects?
4.
I have read that a balanced diet can aid recovery; are there any other rehabilitation methods, such as electrical therapy, that I should consider? (I am currently doing simple strength training exercises.)
I apologize for the numerous questions, but being abroad makes me concerned about communication barriers and missing the critical window for treatment.
I sincerely appreciate your advice.
Thank you very much.

A-Jia, 30~39 year old female. Ask Date: 2018/03/15

Dr. Li Yongheng reply Orthopedics

Hello, based on your symptoms and the X-ray results, the outcomes of having surgery versus not having surgery are indeed quite similar.
Since the fracture has been present for two weeks and the follow-up X-ray on March 14 showed no displacement, I recommend that you do not need surgery.
As long as the fracture heals well, there should not be any significant complications.
It is normal to still have some swelling after two weeks, which can take about 6-8 weeks to subside.
When you are able to walk, soaking in a hot spring can help reduce swelling, but it will not speed up the healing of the bone.
If time permits, you may consider using localized electrical stimulation for rehabilitation, which could help accelerate the healing process of the bone.
Wishing you a speedy recovery.

Reply Date: 2018/03/15

More Info

When considering whether to opt for surgery for a fifth metatarsal fracture, several factors must be taken into account, including the type and severity of the fracture, the patient's overall health, and the potential risks and benefits of surgical intervention versus conservative treatment.

1. Surgical vs. Conservative Treatment: In cases of fifth metatarsal fractures, particularly those that are non-displaced or minimally displaced, conservative treatment is often recommended. This typically involves rest, ice, elevation, and possibly the use of crutches to avoid putting weight on the injured foot. The second hospital's assessment that surgery and non-surgical treatment would yield similar outcomes is a significant consideration. If the fracture is stable and not at risk of displacement, conservative management is often sufficient. However, if there is a risk of displacement or if the fracture is classified as a Jones fracture (which is located at the base of the fifth metatarsal and has a higher risk of nonunion), surgical intervention may be more beneficial.

2. Potential Complications of Non-Surgical Treatment: While many patients recover well with conservative treatment, there can be risks of complications such as malunion or nonunion of the fracture. Malunion occurs when the bone heals in an incorrect position, potentially leading to chronic pain or functional limitations. Nonunion, on the other hand, means the fracture fails to heal properly, which may necessitate surgical intervention later on. Regular follow-up with imaging studies, as your doctor has suggested, is crucial to monitor the healing process.

3. Swelling and Pain Management: It is normal to experience swelling and discomfort for several weeks following a fracture. The healing process can vary significantly from person to person, and factors such as activity level, adherence to rest, and overall health can influence recovery time. If swelling persists, it may be beneficial to continue elevating the foot and applying ice as needed. Gradually increasing weight-bearing activities, as tolerated, can also help improve circulation and reduce swelling.

4. Thermal Therapy and Rehabilitation: Regarding your question about using hot springs for recovery, while warm water can promote relaxation and improve circulation, it is essential to ensure that the foot is not submerged in water that is too hot, as this could exacerbate swelling or discomfort. Always consult with your healthcare provider before engaging in such activities.
5. Nutrition and Rehabilitation: A balanced diet rich in calcium and vitamin D is essential for bone healing. Additionally, engaging in rehabilitation exercises, as you are already doing, can help restore strength and range of motion. Physical therapy may also be beneficial, particularly if you experience stiffness or weakness as you progress in your recovery.

In summary, the decision to undergo surgery for a fifth metatarsal fracture should be made in consultation with your healthcare provider, considering the specifics of your fracture and your personal circumstances. If your doctor believes that conservative treatment is appropriate and you are comfortable with that plan, it is likely a sound choice. Regular follow-up appointments will be crucial to ensure that the fracture is healing correctly and to address any concerns that may arise during your recovery.

Similar Q&A

To Operate or Not: Navigating Fifth Metatarsal Fracture Decisions

Your grandmother is a 75-year-old female with a history of diabetes and hypertension. She suffered a fifth metatarsal fracture in a car accident on December 10 and was treated with a cast. The physician mentioned that surgery is an option, but it is not mandatory. There are diffe...

Dr. Chen Yongxue reply Orthopedics
Hello, fractures of the fifth metatarsal can often be treated conservatively unless there is significant displacement. As long as you properly follow the treatment plan, including wearing a cast and avoiding weight-bearing activities, the healing rate is quite high, so there is n...

Understanding Fifth Metatarsal Fractures: To Operate or Not?

Hello Dr. Shi, last month I had a misstep and fractured my fourth and fifth metatarsals. When I went to the emergency room, the doctor said surgery was optional and that not having surgery wouldn't affect my ability to walk. However, during my outpatient visit, the doctor me...

Dr. Shi Guozheng reply Orthopedics
The doctor's statement is correct; continuous monitoring is sufficient.

Is Surgery Necessary for a 4.5mm Fracture of the Fifth Metatarsal?

Hello, doctor. A few days ago, I was in a car accident and I have a 4.5mm fracture in my fifth metatarsal. The doctor suggested surgery, which would take about 2 months for recovery. If I don't have the surgery, I would need to wear a cast, which would lead to a slower recov...

Dr. Shi Guozheng reply Orthopedics
If the fracture is displaced and will affect future mobility, surgery is necessary; otherwise, conservative treatment can be considered.

Understanding Fifth Metatarsal Fractures: Surgery or Conservative Treatment?

Hello, doctor. I recently suffered a fracture of the fifth metatarsal (with a 2mm displacement) due to an accidental misstep at work. Several doctors have provided me with the option of either surgery or non-surgical treatment, and I'm feeling a bit frustrated about how to d...

Dr. Shi Guozheng reply Orthopedics
Photos can be sent via https://drive.google.com/file and usually do not require surgery.