title: Outcome of nonoperative management of displaced oblique spiral fractures of the fifth metatarsal shaft.
abstract: BACKGROUND
  Nonoperative management has been the preferred treatment for displaced oblique spiral fractures of the fifth metatarsal shaft; yet a paucity of literature supports this claim. The purpose of this investigation was to report the incidence and long-term outcome in the largest cohort of these fractures reported to date.
  
  
  METHODS
  From 2006 through 2010, 2990 patients sustaining closed metatarsal fractures were seen and treated. Displaced, oblique, spiral fractures of the distal shaft of the fifth metatarsal were identified and follow-up was conducted. Only patients who were initially treated with nonoperative management were included. Patients were seen at 6 and 12 weeks, and a minimum 2-year follow-up was conducted. In addition, demographic information was obtained, and the Short Form-12 (SF-12) and Foot and Ankle Ability Measure (FAAM) were administered. Average follow-up was 3.5 years.
  
  
  RESULTS
  In all, 142 acute fractures were managed for an incidence of 4.8% of all metatarsal fractures. There were 117 females and 25 males, average age was 55. FAAM activities of daily living subscale scores averaged 95.5 (±5.7), while FAAM sports subscales were 92.7 (±9.1). SF-12 physical and mental scores averaged 51.4 (±4.9) and 50.3 (±4.6), respectively. There were 2 delayed unions, 1 asymptomatic nonunion treated nonoperatively, and 2 painful nonunions that required open reduction internal fixation with bone grafting.
  
  
  CONCLUSIONS
  This large cohort described the relative incidence and functional outcomes of displaced oblique fracture of shaft of the fifth metatarsal bone treated nonoperatively. Nonoperative management of these fractures resulted in excellent, long-term functional outcomes.
  
  
  METHODS
  Level II, prospective cohort study.
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Aynardi
authors.forename: David I
authors.initials: DI
authors.lastname: Pedowitz
authors.forename: Heather
authors.initials: H
authors.lastname: Saffel
authors.forename: Christine
authors.initials: C
authors.lastname: Piper
authors.forename: Steven M
authors.initials: SM
authors.lastname: Raikin
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D005599:Fractures, Ununited / Q000601:surgery; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: complications; dancer’s fracture; fifth metatarsal; metatarsal fractures; nonsurgical treatment; outcomes