Fifth Metatarsal Neck Fracture: To Operate or Not?

Is surgical reduction necessary for a fracture-dislocation of the fifth metatarsal head and neck?

Hello, Doctor.
Currently, I have a dislocated fracture of the neck of the fifth metatarsal in my left foot, which has been 10 days.
I have consulted several doctors: 1.
Last Saturday, a specialist from Mackay Memorial Hospital's foot and ankle department mentioned that although the metatarsal is dislocated, it appears relatively straight, somewhat resembling a bunion? (I don't quite understand this point.) They suggested wearing a protective shoe for observation for 2 weeks, but could not guarantee that surgery would not be needed after the observation period.
If surgery is required, they would use absorbable bone material instead of a plate.
2.
This Monday, I had an appointment at Cathay Hospital, where the doctor stated that surgery with a plate is necessary for realignment, and that the sooner the surgery is performed, the better; delaying it could complicate the situation.
I would like to ask for your advice: 1.
Is surgery necessary for a dislocated neck of the fifth metatarsal? If I choose to observe for 2 weeks, which would bring the total time close to a month since the fracture, would it complicate matters if surgery is ultimately needed? 2.
If surgery is not performed, could there be negative outcomes, such as being unable to walk, exercise, or dance in the future? 3.
Is this situation similar to a bunion? 4.
Additionally, I wear a protective shoe when going out, but I do not wear it at home and mostly walk with a slight heel-toe gait.
Could this have any impact? Thank you for your assistance.

Emily, 30~39 year old female. Ask Date: 2021/03/03

Dr. Chen Bochen reply Orthopedics

1.
If there is a dislocation of the neck of the fifth metatarsal, is surgery necessary? >>> If it is completely displaced, surgery is generally recommended to reduce the risk of complications and to accelerate healing.
If surgery is not performed, observing for two weeks could lead to a situation where it takes nearly a month to address the fracture, and if surgery is ultimately required, could it be more complicated? >>> Surgery may be more challenging, but it is not impossible to manage.
2.
If surgery is truly not performed, could there be negative outcomes, such as being unable to walk, exercise, or dance in the future? >>> This should be assessed based on X-rays and clinical examinations, as fractures can vary widely, and there is no one-size-fits-all answer.
3.
Is this situation similar to hallux valgus? >>> I am not sure what the original physician intended to convey.
4.
Additionally, I wear protective footwear when going out, but I do not wear it at home.
Most of the time, I walk with a slight heel-toe gait.
Could this have an impact? >>> Yes, just be cautious to avoid further injury.

Reply Date: 2021/03/03

More Info

When considering treatment options for a fifth metatarsal neck fracture, several factors must be taken into account, including the degree of displacement, the patient's activity level, and the potential for complications.
1. Surgical vs. Non-Surgical Treatment: The decision to operate on a fifth metatarsal neck fracture often hinges on the alignment of the fracture. If the fracture is minimally displaced and the bone is still relatively aligned, conservative treatment—such as wearing a protective boot or shoe—may be appropriate. This allows for observation and potential healing without the need for surgery. However, if the fracture is significantly displaced or if there is a risk of complications (such as nonunion or malunion), surgical intervention may be necessary. Surgery typically involves realigning the bone fragments and stabilizing them with screws or plates, which can promote more reliable healing.

2. Timing of Surgery: If surgery is deemed necessary, timing can be crucial. The sooner the fracture is stabilized, the better the chances of a successful outcome. Delaying surgery can lead to complications, including the development of chronic pain, instability, or even arthritis in the joint. If you choose to observe for two weeks and the fracture does not heal properly, you may face a more complex surgical situation later on.

3. Potential Outcomes of Non-Surgical Treatment: If you opt for non-surgical treatment and the fracture does not heal correctly, there is a risk of long-term issues, such as chronic pain, difficulty walking, or limitations in physical activities, including sports or dance. In some cases, improper healing can lead to conditions like a "fifth metatarsal stress fracture," which can be more challenging to treat.

4. Understanding the Comparison to Hallux Valgus (Bunion): The mention of "hallux valgus" (bunion) in your consultation may refer to the alignment of the foot and how the fifth metatarsal fracture could affect overall foot mechanics. Hallux valgus is characterized by the lateral deviation of the big toe, which can influence the alignment and function of the surrounding bones, including the fifth metatarsal. While they are not directly related, understanding the overall foot structure can help in assessing the impact of your fracture.

5. Impact of Protective Footwear: Wearing a protective boot or shoe is essential for providing stability and preventing further injury. If you are walking without proper support, even if you are just using your heel, it can place undue stress on the fracture site and hinder healing. It is advisable to consistently wear the protective footwear as recommended by your physician to ensure the best possible outcome.

In conclusion, the decision to operate on a fifth metatarsal neck fracture should be made in consultation with an orthopedic specialist who can evaluate the specifics of your injury. If surgery is recommended, it is typically to prevent complications that could arise from delayed treatment. If you choose to observe, be aware of the potential risks and ensure that you are following your physician's advice regarding footwear and activity levels. Always prioritize open communication with your healthcare provider to make informed decisions about your treatment plan.

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