Pseudarthrosen des Metatarsale 5: Welche Fraktur ist „at risk“? Behandlungsstrategie der Pseudarthrose

Fractures of the base of the fifth metatarsal bone are among the most common fractures of the foot. Some of these fractures heal quickly and without complications with non-operative therapy, while others often lead to symptomatic non-unions. Accordingly, proper classification is critical for a successful treatment. The best therapy for a non-union is to prevent it. Fractures at the distal end of articulation of fourth and fifth metatarsal (meta-diaphyseal fractures) have a high risk for non-unions when treated non-operatively. Operative treatment using intramedullary screw fixation on the other hand, leads to reproducibly good results. Accordingly, operative treatment should be recommended. If a non-union develops, it is result of non-operative treatment in most cases. Only symptomatic non-unions necessitate further treatment. Initially, shock wave therapy should be considered. Most authors recommend isolated intramedullary screw osteosynthesis. An open curettage of the non-union or even a bone grafting do not seem to be necessary.