1. Case for small group discussion
Metatarsal fracture
Case for small group discussion
AOTrauma—Foot & Ankle
Module 5: Forefoot trauma
Stefan Rammelt, DE

2. Case description 21-year-old marathon runner
8 weeks after sustaining a stress fracture
Nonunion of fifth metatarsal proximal metaphysis

3. 10 months post injury
Debridement, plate fixation

4. 14 months postinjury—persistent nonunion

5. Revision

6. 1-year follow-up x-rays
Solid fusion
Patient is pain free

7. Take-home messages Low healing potential (watershed area)
Look for foot deformities in stress fractures
Revision—intramedullary screw with cortical thickening
Resection and bone grafting for complete nonunion (obliteration of medullary canal)
Reference:
Torg JS, et al. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66(2):209–214.
Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury Sep;Suppl:SB77–SB86.
Torg JS, et al. J Bone Joint Surg Am. 1984;66(2):209–214.
Rammelt, et al. Injury. 2004;Suppl:SB77–SB86.