Fifth metatarsal fractures among male professional footballers

There is little information about Metatarsal Five (MT-5) fractures for specific sports.

The objective here was to study the occurrence, the imaging characteristics, the lay-off times and healing problems of MT-5 fractures among male footballers. Sixty-four European elite teams were monitored from 2001 to 2012. x-Rays were collected and classified by the Torg criteria.

Results 

Of 13 754 injuries, 0.5% (67) proved to be MT-5 fractures. Their incidence was 0.04 injuries/1000 h of exposure. A team of 25 players might thus expect an MT-5 fracture every fifth season. Of these fractures, 67% (38) were primary and 33% were refractures. One of the 38 primary fractures was an avulsion of the tuberosity; all the others (97%) located towards the base. In total, 32% of the players with MT-5 fracture were younger than 21 years, 40% of the fractures occurred during the preseason and 45% of the players had prodromal symptoms. In total, 54% of the initial x-rays were classified as Torg type II (stress fractures), and 46% were classified as Torg type I (acute type). After surgical treatment the fractures healed faster, compared with conservative treatment (75% vs 33%, p<0.05). There was no significant difference in lay-off days between players that had been operated, and those that had not (80 vs 74 days, p=0.67).

Conclusions 

The majority of MT-5 fractures are stress fractures, and mainly occur among young players. There are frequent healing problems, which might be explained by the stress nature of the injury. After surgery there are less healing problems, compared with those in conservative treatment.

Commentary

This study shows that the MT-5 fracture is a rare injury in football, and with a high rate of healing problems.

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A second main finding is that almost all MT-5 fractures in footballers are located at the base of the bone while avulsions are very rare. A transverse fracture through the proximal part or base of the bone, usually referred to as Jones Fracture, is reported to be associated with a high rate of healing problems.

Another main finding, from this study, was that players suffering MT-5 fractures were significantly younger than those who did not. This finding accords with other studies of stress-fractures among athletes.1–3

References

  1. Dameron TB Jr.. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am 1975;57:788–92. r
  2. Josefsson PO, Karlsson M, Redlund-Johnell I, et al. Jones fracture. Surgical versus non-surgical treatment. Clin Orthop Relat Res 1994;299:252–5.
  3. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg Am 1978;60:776–82.

Simon Bartold
Director of Bartold Clinical

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