Factors Associated with Non-Unions of Fifth Metatarsal Fractures

Objectives: Metatarsal fractures account for ۵-۶% of all fractures presenting to emergency care centers with ۶۸% being fifth metatarsal (۵MT) fractures. While most heal uneventfully, non -union is one of the most common complications regardless of treatment modality. Predicting the risk for non-union would potentially change treatment decisions thus lowering burden on patients and the healthcare system. The aim of this study was to identify factors associated with non -union in ۵MT fractures.Methods: In this retrospective case-control study, ۷۳۱ patients met inclusion criteria. Radiographs and clinical documentation were utilized to determine fracture characteristics and final healing status. ۵۴۷ were assigned to the union group and ۱۸۴ to the non-union group. Patients’ data were gathered and analyzed using machine learning methods, as well as Mann-Whitney U, Pearson R chi-square test, and multivariable logistic regression analysis. P<۰.۰۵ was considered statistically significant.Results: The overall radiographic non-union rate was ۲۵.۲%. The highest incidence of non-union was observed for Zone ۳ fractures (۳۱.۲%). Fracture displacement (P=۰.۰۳) was found to have an independent correlation with healing. Several chronic conditions such as osteoporosis (P=۰.۰۳), irritable bowel syndrome (P=۰.۰۱), cardiovascular disease (P=۰.۰۱) and sleep apnea (P=۰.۰۳), were found to have an independent correlation with healing. Beta-blockers (P=۰.۰۴۷) and topical steroids (P=۰.۰۴) were also found to be associated with ۵MT nonunion.Conclusion: In this study, we identified several non-traditional factors associated with ۵MT fracture non-union that warrant further consideration and may assist clinicians during the decision-making process. The relationship between non-fracture related factors with non-union needs to be further examined via larger clinical studies before causality can be determined and designation of those variables as risk factors. Level of evidence: III

کلیدواژه ها:

Fifth Metatarsus ، Jones Fracture ، Metatarsal Fractures ، nonunion