Nonunion Following Diaphyseal Stress Fracture of the Second Metatarsal: A Case Report

Abstract

Stress fractures of the metatarsal diaphysis are generally classified as low-risk fractures and usually heal with conservative management. Here, we report a rare case of nonunion following a diaphyseal stress fracture of the second metatarsal in a 14-year-old female cheerleader. The patient initially presented with midfoot pain, and radiographs revealed complete diaphyseal fractures of the second and third metatarsals. Despite a recommendation to rest, she continued cheerleading activities and later developed nonunion of the second metatarsal. Surgical fixation with autologous bone grafting was performed using the dorsal approach. Postoperatively, gradual weight bearing was resumed, and bone union was achieved 3 months after surgery, allowing the patient to return to sports at 3 months. This case demonstrates that even low-risk stress fractures may progress to nonunion when activity restrictions are not properly observed. Appropriate patient education, compliance with rest, and early management are essential for preventing such complications.

Figure 1Anteroposterior views of plain radiographs.(a) Complete diaphyseal fractures are observed in the second and third metatarsals during the first visit to a local clinic. Callus formation is observed in the third metatarsal (arrowheads). (b) Bone union is achieved in the third metatarsal, whereas the second metatarsal shows nonunion with bone loss and shortening (double-headed arrow) on the first visit to our hospital.