European Journal of Trauma and Emergency Surgery

, Volume 44, Issue 5, pp 727–734 | Cite as

The outcome of proximal fifth metatarsal fractures: redefining treatment strategies

  • P. Monteban
  • J. van den Berg
  • J. van Hees
  • S. Nijs
  • H. HoekstraEmail author
Original Article



To optimize the treatment strategy and reduce treatment costs of proximal fifth metatarsal fractures, clinical and patient-reported outcome, and its determinants were addressed.


A retrospective adult cohort study including 152 proximal fifth metatarsal fractures: 121 nonoperatively and 31 operatively treated. In the operative group, 21 were zone 1 and 10 zone 2 fractures. Median follow-up was 37.5 (IQR 20.8–52.3) months with a minimal follow-up of 6 months. Twenty-three demographic, fracture, and treatment characteristics were assessed as well as the healthcare costs. Outcome was assessed using the patient files, anterior-posterior and oblique X-rays, foot function index (FFI), visual analog score (VAS), and SF-36 questionnaires.


The median FFI, physical SF-36, and VAS scores did not significantly differ between nonoperatively and operatively treated patients. The FFI and physical SF-36 were predominantly affected by a history of mobility impairment and pre-existent cardiovascular diseases, whereas mental SF-36 correlated significantly with higher ASA-score. Overall complication rate was 5.9% (4.1 vs. 12.9%; p = 0.065, nonoperative vs. operative, respectively). Nonunion was recorded in only one (nonoperatively) treated patient. The total healthcare costs for operative treatment were 4.2 times higher compared to nonoperative treatment (€1960 vs. €463 per patient, respectively).


Overall, the clinical and patient-reported outcome was good. The foot function and quality of life were mainly affected by comorbidity, rather than fracture and treatment-related variables. Although nonoperatively treated patients indicated decreased mental quality of life, our study indicates that proximal fifth metatarsal fractures can safely be treated nonoperatively without the risk of nonunion, with fewer complications and lower healthcare costs.

Level of evidence



Fractures Metatarsal Management Outcome Costing 



American Society of Anesthesiologists physical status score


Body mass index


Deep venous thrombosis


Cardiovascular risk factors


Foot function index


Short form 36


Visual analog scale


Length of stay


Interquartile range


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants


Informed consent



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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • P. Monteban
    • 1
  • J. van den Berg
    • 2
  • J. van Hees
    • 2
  • S. Nijs
    • 1
    • 3
  • H. Hoekstra
    • 1
    • 3
    Email author
  1. 1.Department of Trauma SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Faculty of MedicineKU Leuven-University of LeuvenLeuvenBelgium
  3. 3.Department of Development and RegenerationKU Leuven-University of LeuvenLeuvenBelgium

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