title: Excision of symptomatic nonunions of proximal fifth metatarsal avulsion fractures in elite athletes.
abstract: BACKGROUND
  An avulsion fracture of the proximal fifth metatarsal may result in a symptomatic nonunion and hinder athletic performance. Nonoperative management is often successful in alleviating symptoms. When symptoms persist, surgery can be undertaken to repair the nonunion or excise the avulsed fragment.
  
  
  OBJECTIVE
  The excision of the avulsed bone fragment is evaluated in the management of symptomatic nonunions.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Excision of the avulsed fifth metatarsal fragment was performed in 6 male high-performance athletes with symptomatic nonunions. The remaining edge of bone was contoured and smoothed.
  
  
  RESULTS
  All 6 patients experienced an uneventful operation and recovery, returning to competitive play at a mean of 11.7 weeks. Activity-related pain and discomfort abated after the excision and rehabilitation. No surgical complications were noted.
  
  
  CONCLUSIONS
  Surgical excision of the avulsed fragment from the proximal fifth metatarsal is a safe and effective alternative intervention when nonoperative methods fail.
authors.affiliation: University of Kentucky, 496 Longview Drive, Lexington, KY 40503, USA. David.Ritchie@uky.edu
authors.forename: J David
authors.initials: JD
authors.lastname: Ritchie
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Shaver
authors.forename: Robert B
authors.initials: RB
authors.lastname: Anderson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lawrence
authors.forename: Scott D
authors.initials: SD
authors.lastname: Mair
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery; D050723:Fractures, Bone / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries* / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods / Q000534:rehabilitation; D010146:Pain / Q000534:rehabilitation; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult