Fracture of the base of the fifth metatarsal in athletes treated with intramedullary AO cancellous screw fixation

Abstract

Background: Stress fracture of the fifth metatarsal bone is a common injury in athletes. The purpose to this study was to review the long-term clinical results of internal fixation with a solid 6.5 mm cancellous AO screw in active patients.

Materials and methods: Retrospective study of all patients treated surgically at Volvat Medical Centre in Oslo from 1995 – 2006. 37 patients with 40 stress fractures of the fifth metatarsal bone were treated with AO screw fixation. 36 patients with 39 fractures were available for interviews. 29 were soccer players, four team handball players, two long distance runners and one was played basketball. The group consisted of two female and 35 male athletes. The average age was 23.7 years (17-32) and average follow up time was 5.3 years (10.1 – 146.2 months). 30 of the fractures were previously treated conservatively (76.9%), leading either to delayed union, refracture, non-union or pseudoarthrosis.

Results: All fractures healed and there were no recurrence of fracture. Treatment was rated successful if the patient was able return to full pre-injury level. 36 of 39 (92.3%) cases returned to full level of activity. The time from surgery until return to pre-injury level varied from 5.6-22.4 weeks, median 8.6 weeks. There were no infections. 10 patients felt tenderness when kicked or stepped on, but this did not limit their activity. 38 out of 39 operations resulted in patient satisfaction and they would have gone through the same treatment again. Of the 39 operations, 36 of the patients came to the conclusion that they would have preferred surgical treatment as the first treatment option.

Conclusion: Athletes with stress fracture of the fifth metatarsal bone can be successfully treated with AO 6.5 mm cancellous screw fixation. Athletes with a refracture or failed conservative treatment should be treated this way.