Treatment of Fifth Metatarsal Zone 3 Fractures

The fifth metatarsal is one of the bones where stress fractures can occur. Current literature provides support for both operative and non-operative treatment, but is mostly based on retrospective studies. One small randomized controlled trial reported faster recovery in the surgery group, but this study is probably subject to selection bias as well as underpowered design. There is a need to strengthen the knowledge base regarding treatment of stress fractures in the fifth metatarsal. This study seeks to answer whether osteosynthesis with an intramedullar screw fixation gives faster painfree weight bearing compared to non-operative treatment with a walking boot.

The patients in this arm will be treated operatively with intramedullar screw osteosynthesis. In addition to this, they will weight bear as tolareted in a walking boot orthosis for six weeks.

The patients in this arm will have non-operative treatment with a walking boot orthosis for six weeks. They will weight bear as tolerated

Non-operative treatment with walking boot orthosis for six weeks. The non-operative study arm will use walking boot orthosis only. The operative study arm will use walking boot orthosis as adjuvant treatment.

Defined as Visual Analoge Scale below 3. The scale range is 0 to 10, where 0 means "no pain" and 10 means "worst pain".

Inclusion Criteria: Zone 3 fracture Exclusion Criteria: Neuropathy Open fractures High energy injuries Associated injury in the same or opposite extremity that may affect treatment or rehabilitation Pressure ulcer(s) Lack of consent competence Fracture radiologically confirmed more than six months ago No possibility of follow-up at one of the study centers Established pseudarthrosis Medical condition that contraindicates surgery Non-compliance