title: Fourth metatarsal base stress fractures in athletes: a case series.
abstract: BACKGROUND
  Metatarsal stress fractures account for approximately 28% of all stress fractures reported in the literature. Second and third metatarsal stress fractures are most common, followed by fractures of the fourth and fifth metatarsal. Reports in the literature suggest that proximal fourth metatarsal stress fractures have the same propensity for delayed healing and nonunion as do fifth metatarsal stress fractures. There is a paucity of literature on operative management of fourth metatarsal fractures. This study reports the results of operative management of fourth metatarsal stress fractures in athletes.
  
  
  METHODS
  A retrospective review with prospectively collected data was undertaken to evaluate utility of operative care of fourth metatarsal stress fractures in an athletic population desiring early return to sports. Eleven athletes over a 13-year period were enrolled with proximal fourth metatarsal stress fractures. The American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot scores were obtained pre- and postoperatively. Midfoot alignment, including the presence or absence of metatarsus adductus, radiographic time to healing, and time to return to sports were also recorded.
  
  
  RESULTS
  All patients were treated with operative open reduction and internal plate fixation with calcaneal autograft. Four of the 11 patients had metatarsus adductus. All had evidence of radiographic healing prior to return to activity, all returned to sports at an average of 12 weeks post surgery, and all would choose surgery again given the same injury. The AOFAS Midfoot scale improved from an average of 55 preoperatively to 94 postoperatively (P < .001) CONCLUSION: Our study suggests that operative repair of fourth metatarsal stress fractures hastens time of healing and return to sports in athletes. It also supports the theory that there is a correlation between metatarsus adductus lateral metatarsal stress fractures.
  
  
  METHODS
  Level IV, retrospective case series.
authors: University of Wisconsin-Madison, Orthopedics and Rehabilitation, Madison, WI, USA. kurt.rongstad@uwmf.wisc.edu
authors: Kurt M
authors: KM
authors: Rongstad
authors: Jonathan
authors: J
authors: Tueting
authors: Meriel
authors: M
authors: Rongstad
authors: Katie
authors: K
authors: Garrels
authors: Ryan
authors: R
authors: Meis
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D015775:Fractures, Stress / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: forefoot disorders; metatarsal fractures; outcome studies; sports; trauma