Skeletal Radiology

, Volume 43, Issue 4, pp 467–474 | Cite as

Radiographic classification for fractures of the fifth metatarsal base

  • Alexander T. Mehlhorn
  • Jörn Zwingmann
  • Anja Hirschmüller
  • Norbert P. Südkamp
  • Hagen SchmalEmail author
Scientific Article



Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed.

Materials and methods

A cohort of 95 healthy, sportive, and young patients (age ≤ 50 years) with avulsion fractures of the MTB5 was included in the study and divided into groups with non-displaced, primary-displaced, and secondary-displaced fractures. Radiomorphometric data obtained using standard oblique and dorso-plantar views were analyzed in association with secondary displacement. Based on this, a classification was developed and checked for reproducibility.


Fractures with a longer distance between the lateral edge of the styloid process and the lateral fracture step-off and fractures with a more medial joint entry of the fracture line at the MTB5 are at higher risk to displace secondarily. Based on these findings, all fractures were divided into three types: type I with a fracture entry in the lateral third; type II in the middle third; and type III in the medial third of the MTB5. Additionally, the three types were subdivided into an A-type with a fracture displacement <2 mm and a B-type with a fracture displacement ≥ 2 mm. A substantial level of interobserver agreement was found in the assignment of all 95 fractures to the six fracture types (κ = 0.72). The secondary displacement of fractures was confirmed by all examiners in 100 %.


Radiomorphometric data may identify fractures at risk for secondary displacement of the MTB5. Based on this, a reliable classification was developed.


Radiomorphometry Fracture Fifth metatarsal base Classification 


Conflict of interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.


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Copyright information

© ISS 2014

Authors and Affiliations

  • Alexander T. Mehlhorn
    • 1
  • Jörn Zwingmann
    • 1
  • Anja Hirschmüller
    • 1
  • Norbert P. Südkamp
    • 1
  • Hagen Schmal
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Freiburg Medical CenterFreiburgGermany

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