Displaced Fourth Metatarsal Fracture: Surgery vs. Non-Surgery Outcomes

The difference between surgical and non-surgical treatment for a displaced fourth metatarsal fracture?

Due to a fall from a height, a fracture of the fourth metatarsal in the right foot occurred, with an oblique displacement.
Initially, a cast was applied in the emergency department.
Since the patient continued to walk on the heel of the affected foot due to work in the food service industry, an inflatable ankle brace was used by the orthopedic doctor three days later.
Two weeks later, X-rays showed that the oblique angle of the fracture had increased from 2.01 mm to 4.02 mm.
The doctor recommended surgical treatment.
I would like to ask if this angle is considered significant.
If surgery is not performed, will an increasing angle of displacement complicate the healing process of the bone?

Lily, 30~39 year old female. Ask Date: 2024/04/16

Dr. Shi Guozheng reply Orthopedics

A single metatarsal fracture with minimal displacement can be treated conservatively, and it will heal in the future; however, continuous outpatient follow-up is necessary.

Reply Date: 2024/04/16

More Info

A displaced fourth metatarsal fracture, especially one that is oblique and has significant angulation, can present a challenging clinical scenario. In your case, the initial treatment involved casting, which is a common first step for managing such fractures. However, the subsequent increase in angulation from 2.01 mm to 4.02 mm is concerning and suggests that the fracture is not healing properly in alignment.

Understanding Displaced Fractures
Displaced fractures occur when the bone fragments are not aligned properly. The degree of displacement is often measured in millimeters and can significantly affect the healing process. In the case of metatarsal fractures, proper alignment is crucial for restoring function and preventing long-term complications.

Surgical vs. Non-Surgical Treatment
The decision between surgical and non-surgical treatment depends on several factors, including the degree of displacement, the patient's activity level, and the potential for complications.
1. Surgical Treatment: If the fracture is significantly displaced (which, in your case, it appears to be), surgery may be recommended. Surgical options typically involve realigning the bone fragments and stabilizing them with screws, plates, or pins. This approach can facilitate proper healing and restore function more effectively, especially for individuals who are active or have specific occupational demands, such as working in the restaurant industry.

2. Non-Surgical Treatment: Non-surgical management, such as casting or using a walking boot, may be appropriate for less severe displacements. However, as you've experienced, if the fracture does not heal correctly, the risk of malunion (improper healing) increases. This can lead to chronic pain, deformity, and functional limitations.

Implications of Increased Angulation
The increase in angulation you mentioned (from 2.01 mm to 4.02 mm) indicates that the fracture is becoming more misaligned. This can complicate the healing process in several ways:
- Healing Difficulty: Greater displacement can lead to malunion, where the bone heals in an incorrect position. This can result in ongoing pain and dysfunction.

- Long-term Complications: If the fracture heals improperly, it may lead to issues such as arthritis in the joint, chronic pain, or difficulty with weight-bearing activities.

- Functional Limitations: As someone who works in a physically demanding job, improper healing could significantly impact your ability to perform daily tasks and may require extended recovery time.

Recommendations
Given the current situation, it is advisable to consider surgical intervention, especially since the fracture has shown increased displacement. Surgery can provide the best chance for proper alignment and healing, allowing you to return to your normal activities with minimal complications.

Additionally, it is essential to follow up closely with your orthopedic surgeon. They can provide personalized advice based on the specifics of your fracture and your overall health. If surgery is performed, rehabilitation will also be crucial to restore strength and function to your foot.

In conclusion, while non-surgical options are available, the increasing displacement of your fracture suggests that surgical intervention may be the most effective way to ensure proper healing and minimize the risk of long-term complications. Always consult with your healthcare provider to discuss the best course of action tailored to your specific circumstances.

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