Dear Ezequiel

The ideal would be other radiographic incidences. This is a fracture of the fifth metatarsal midlle third with shortening. My choice is surgical fracture reduction and fixation with mini fragment plate and screws

I would prefer Nelson Elias's method and use a small locking plate. I believe an anatomic reduction is needed in this area in order to avoid pain later on especially during exercise in active patients. Hardware removal will be necessary in some of those cases with tendeness above the implant. Be careful with the reduction clamp - metatarsal bone is somewhat fragile.

Hello Ezequiel.

We prefer non surgical treatment because is an oblique fracture and there are not shortening too much. This fractures has high index consolidations. In these anatomic place the hardware must be removed.

We treatment is 4 weeks with walker boot.

Best regards

I shall opt for nonoperative treatment because the weight bearing arch of MTP joints is well preserved.

thanks all for the answer. I asked to Dr Myerson ank he recommend nonsurgical treatment, Dr Lew Schon recommend surgical treatment and Prof Nyska also recommend non surgical treatment. Thanks again

Determine "active". Is he active as going to his desk work? Is he active as a postman? Is he active as a gymnast? For the first patient I would indicate non operative treatement, as this is almost a "reverse Wilson's osteotomy". For the others I would possibly offer surgery and I disagree that the transverse arch is preserved as the 5th metatarsal head in case of weight bearing will be displaced upwards and the loads will be transfered to the 4th.

Dear colleagues, I would remind the classic axioma that " a radiograph in one plane is no radiograph in trauma management". So any opinion for surgical or non-surgical treatment in the discussion above seems to me to be invalid. Sorry.

Great answer Panayot and agree completely with you. But as a "dreamer" I was thinking that we could imaging that the AP of the foot will show a proximal and medial displacement of the apex of the distal fragment. Do you think that you can imaging it this way?? Great dream

Yes, such a displacement could be possible. But in this case there are also no data about the mechanism of trauma. In the area of the foot the action of the traumatic agent may influence the vectors of displacement.