Tension-band wiring for fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis

Background: Fractures of the proximal fifth metatarsal, other than those involving the tuberosity, have a tendency to delayed union or even nonunion. Hypothesis: Tension-band wire technique is a good alternative in treating fractures of the fifth metatarsal located in the proximal junction of the metaphysis and the diaphysis. Study Design: Case series; level of evidence, 4. Methods: Between 1996 and 2001, a total of 27 cases of proximal metaphysial/diaphysial fractures of the fifth metatarsal were treated with tension-band wiring. All of the patients had undergone prior unsuccessful nonoperative or operative treatment. The mean delay from the diagnosis of the fracture to the final operative procedure was 19.5 weeks (range, 6-48 weeks). Results: The mean length of follow-up was 35 months (range, 12-70 months). All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 12.8 weeks, and the return to full activity took 8 to 20 weeks (mean, 14.7 weeks). There were no delayed unions, nonunions, or refractures during the follow-up. Conclusion: The tension-band wire technique seems to give good results in the treatment of proximal metaphysial/diaphysial fractures of the fifth metatarsal in cases of primary unsuccessful nonoperative treatment or primary unsuccessful intramedullary screw fixation.