{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:45:45Z","timestamp":1792500345539,"version":"4.5.0"},"reference-count":58,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T00:00:00Z","timestamp":1590796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T00:00:00Z","timestamp":1590796800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T00:00:00Z","timestamp":1590796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was performed to identify studies published from the earliest record to January 2019 using EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies. 627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment. Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases. For Jones\u2019 (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively. Only ten proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Acute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. In contradistinction, acute zone 2 fractures demonstrate higher union rates and faster time to union when treated surgically. The outcomes of acute zone 3 fractures are rarely reported in the literature, so treatment recommendations remain unclear. Further research of proximal fifth metatarsal fractures is warranted to provide more definitive conclusions, but current findings can aid surgeons during the shared clinical decision making process.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06072-8","type":"journal-article","created":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T10:02:35Z","timestamp":1590832955000},"page":"1284-1293","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Adequate union rates for the treatment of acute proximal fifth metatarsal fractures"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8134-5419","authenticated-orcid":false,"given":"Q. G. H.","family":"Rikken","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands"},{"name":"<!--<label>3<\/label>--> Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"<!--<label>4<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Dahmen","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands"},{"name":"<!--<label>3<\/label>--> Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"<!--<label>4<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8116-9948","authenticated-orcid":false,"given":"N. C.","family":"Hagemeijer","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. N.","family":"Sierevelt","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands"},{"name":"<!--<label>3<\/label>--> Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"<!--<label>4<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC Amsterdam The Netherlands"},{"name":"<!--<label>6<\/label>--> Specialized Center of Orthopedic Research and Education (SCORE) Xpert Ortopedie Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M. M. J.","family":"Kerkhoffs","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands"},{"name":"<!--<label>3<\/label>--> Academic Center for Evidence Based Sports Medicine (ACES) Amsterdam The Netherlands"},{"name":"<!--<label>4<\/label>--> Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. W.","family":"DiGiovanni","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston USA"},{"name":"<!--<label>5<\/label>--> Foot and Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital, Newton\u2010Wellesley Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,30]]},"reference":[{"key":"e_1_2_12_2_2","first-page":"12","article-title":"Traitement symptomatique des fractures non d\u00e9plac\u00e9es de la base du cinqui\u00e8me m\u00e9tatarse: \u00e9tude prospective","volume":"3","author":"Van AJ","year":"2007","journal-title":"Rev Med Suisse"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078300300511"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1893-6"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.11138\/mltj\/2017.7.3.532"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-008-8148-z"},{"key":"e_1_2_12_7_2","first-page":"e71","article-title":"Surgical results of zones i and ii fifth metatarsal base fractures using hook plates","volume":"36","author":"Choi JH","year":"2012","journal-title":"Orthopedics"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0222-7"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197557060-00010"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640012444730"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658301100513"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.0581"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2012-092096"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2008.02.002"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200305000-00008"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpb.0000271323.56610.da"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-13"},{"key":"e_1_2_12_19_2","first-page":"697","article-title":"I. 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March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"C.W. DiGiovanni reports board membership of AOFAS, FAI, FAO and Eur J FAS. No other authors reported receiving funding for this study or any other conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No funding was received for this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate\/publish"}}]}}