Zone 2 Fifth Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively

OBJECTIVES:To quantify the rate of union and time to clinical and radiographic healing in Zone 2 proximal fifth metatarsal (MT) fractures and compare these outcomes between Zone 2 fractures treated operatively and nonoperatively.Design:Retrospective cohort study.Setting:Academic Level I Trauma Center.Patient Selection Criteria:Patients with fifth MT fractures who presented between December 2012 and April 2022 and confirmed to have Zone 2 fractures (defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view) were included in the study analysis in either the operative or nonoperative cohort.Outcome Measures and Comparisons:Nonunion, time to clinical healing by, and time to radiographic healing between operative and nonoperative treatment.RESULTS:Among the 499 included patients, 475 patients (95.2%) were initially treated nonoperatively and 24 patients (4.8%) were treated operatively. Both groups were similar in demographics. There was no difference in the proportion of patients with nonunions between groups (6.1% in the nonoperative group vs. 3.8% in the operative group, P = 1.000). In addition, there was no statistically significant difference between groups with respect to the time to clinical healing (9.9 +/- 8.3 weeks for the nonoperative group vs. 15.4 +/- 15.0 weeks for the operative group, P = 0.117) or the time to radiographic healing (18.7 +/- 12 weeks for the nonoperative group vs. 18.5 +/- 16.6 weeks for the operative group, P = 0.970).CONCLUSIONS:Zone 2 fifth MT base fractures were successfully treated with nonoperative management. There was no evidence in this study that operative treatment leads to significantly faster clinical or radiographic healing.LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.