PubMed^® Literature Review

Intramedullary screw fixation has emerged as a preferred surgical technique for addressing non-unions of the fifth metatarsal [1], with various studies reporting high rates of success when larger diameter screws are used [1][2]. A study utilizing a larger diameter 5.5 mm cannulated variable-pitch compression titanium screw reported radiological union achieved at an average of 7.2 weeks postoperatively with satisfactory functional outcomes [1]. Similarly, another study highlighted that smaller-diameter screws significantly increased the risk of bone union disorder compared to larger ones (odds ratio 4.81) [2].

While intramedullary screw fixation remains popular, alternative methods such as plantar-lateral plating have been explored due to some reports of failures after screw fixation in athletes [6][8]. Plantar-lateral plate fixation was shown to allow more cycles and higher peak loads before failure compared to intramedullary screws when tested under cantilever bending conditions in cadaveric specimens simulating Jones fractures [4].

The timing and protocol for weightbearing following surgery is also crucial since early mobilization can facilitate functional recovery without compromising healing outcomes [5][7]. Studies comparing early weightbearing (EWB) protocols against delayed weightbearing (DWB) did not find significant differences in healing times or rates between both groups; thus EWB may be safe following solid intramedullary screw fixation without increasing risks for delayed unions or nonunions [5].

Despite these findings suggesting that aggressive rehabilitation does not hinder fracture healing or delay bone union timeframes necessary for return-to-play among professional soccer players were observed shortest amongst those treated promptly with surgical stabilization followed by early limb loading post-surgery starting from week two after surgery intervention[10].

Overall consensus suggests that operative treatment leads to better outcomes than conservative management across acute fractures, delayed unions, and non-unions[3][9][11]. For competitive athletes where refracture is a concern after initial treatment with small diameter screws[12], maximizing initial fixation stiffness through appropriate selection of implant size may reduce late failure rate.

In conclusion, strain reduction screw technology applied via an appropriately sized intramedullary device seems beneficial for achieving union in cases of fifth metatarsal non-union. Early weightbearing protocols do not appear detrimental if implemented cautiously post-surgery while considering individual patient factors such as age which might influence healing dynamics.