Introduction and purpose  

Intramedullary screw fixation (ISF) of proximal fifth-metatarsal fractures is known as first treatment option in young, sports active patients. No study analyzed functional and biomechanical outcome before. Hypothetically ISF leads to (1) a high bony union rate within 12 weeks, (2) normal hindfoot eversion strength, and (3) normal gait and plantar pressure distribution.

Methods  

Fourteen out of 22 patients were available for follow-up with an average follow-up of 42 months; clinical and radiological follow-up, and biomechanical evaluation by isometric muscular strength measurement (inversion, eversion strength) and dynamic pedobarography, comparing to the non-affected contralateral foot. Level of significance: 0.05.

Results  

Subjective result: Excellent or good result in 14 patients, none fair or poor. AOFAS midfoot score: 100 points in 13 patients and 87 points in 1 patient. The same sports activity level (0–4) was reached in 13 out of 14 patients. Radiologic examination: consolidation after 6 weeks in 9 patients and after 12 weeks in another 4 patients, one partial union. Average maximal eversion strength 59 N (ratio to the contralateral foot: 0.92, not significant). Dynamic pedobarography showed ratios of 0.99–1.01 to the contralateral side for ground reaction force, ground peak time, peak pressure and contact area (not significant).

Interpretation  

A very-high patient-satisfaction, a fast bony healing and complete return to sports were documented. Muscular strength measurement and dynamic pedobarography showed complete functional rehabilitation. Therefore, ISF in proximal fifth-metatarsal fractures can be recommended as a secure procedure.