Concerning nondisplaced tuberosity avulsion fractures of the proximal 5th metatarsal, which management is recommended?

Concerning nondisplaced tuberosity avulsion fractures of the proximal 5th metatarsal, which management is recommended?

• A. Conservative treatment with elastic wrapping, ankle splints, and low-profile walking boots, with weight bearing as tolerated; resolution in 3-6 weeks
• B. Immediate surgical fixation
• C. Long-leg cast with nonweight bearing for 8 weeks
• D. Return to activity within 1 week

Answer: (B)

Nondisplaced tuberosity avulsion fractures of the proximal fifth metatarsal heal well with nonoperative care. These injuries involve the small bump where the peroneus brevis tendon pulls off a piece of bone, but when the fragment remains aligned, the blood supply and bone healing are favorable with proper immobilization and protection. The typical approach is immobilization in a walking boot, short leg cast, or splint with weight bearing as tolerated based on comfort and clinician preference. Healing usually occurs over several weeks, commonly around 3–6 weeks, after which gradual return to activity and structured rehab is pursued once pain and function allow. The key is maintaining alignment during healing and avoiding displacement. Surgical fixation is generally reserved for cases where the fragment is displaced, there is instability, there is articular involvement, or there is failure to heal with conservative management. In those scenarios, surgery may be considered to restore stability and promote a reliable return to function, especially in athletes who require rapid recovery.

Nondisplaced tuberosity avulsion fractures of the proximal fifth metatarsal heal well with nonoperative care. These injuries involve the small bump where the peroneus brevis tendon pulls off a piece of bone, but when the fragment remains aligned, the blood supply and bone healing are favorable with proper immobilization and protection.

The typical approach is immobilization in a walking boot, short leg cast, or splint with weight bearing as tolerated based on comfort and clinician preference. Healing usually occurs over several weeks, commonly around 3–6 weeks, after which gradual return to activity and structured rehab is pursued once pain and function allow. The key is maintaining alignment during healing and avoiding displacement.

Surgical fixation is generally reserved for cases where the fragment is displaced, there is instability, there is articular involvement, or there is failure to heal with conservative management. In those scenarios, surgery may be considered to restore stability and promote a reliable return to function, especially in athletes who require rapid recovery.