Excision of Symptomatic Nonunions of Proximal Fifth Metatarsal Avulsion Fractures in Elite Athletes

Background: An avulsion fracture of the proximal fifth metatarsal may result in a symptomatic nonunion and hinder athletic performance. Nonoperative management is often successful in alleviating symptoms. When symptoms persist, surgery can be undertaken to repair the nonunion or excise the avulsed fragment. Purpose: The excision of the avulsed bone fragment is evaluated in the management of symptomatic nonunions. Study Design: Case series; Level of evidence, 4. Methods: Excision of the avulsed fifth metatarsal fragment was performed in 6 male high-performance athletes with symptomatic nonunions. The remaining edge of bone was contoured and smoothed. Results: All 6 patients experienced an uneventful operation and recovery, returning to competitive play at a mean of 11.7 weeks. Activity-related pain and discomfort abated after the excision and rehabilitation. No surgical complications were noted. Conclusion: Surgical excision of the avulsed fragment from the proximal fifth metatarsal is a safe and effective alternative intervention when nonoperative methods fail.