High-resolution peripheral quantitative CT of the proximal fifth metatarsal reveals microstructural similarity between Lawrence and Botte zones I and II

Sep 29, 2026

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The study addresses ongoing controversy over optimal treatment of proximal fifth metatarsal (MT-V) fractures classified by Lawrence and Botte into zones I–III. Using high-resolution peripheral quantitative CT (HR-pQCT), trabecular and cortical microarchitecture at the MT-V base was quantified across zones and compared with linear regression to assess demographic influences. Results showed trabecular decline and cortical parameter increase from zones I to III, with greater structural similarity between zones I and II than between zones II and III, and female sex plus advanced age linked to poorer microarchitecture. Findings support a similarly favorable healing potential for zone II as for zone I, while also highlighting heightened fracture susceptibility in women and the elderly.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Aims

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Results

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Strengths and limitations

Introduction

High-resolution peripheral quantitative CT of the proximal fifth metatarsal reveals microstructural similarity between Lawrence and Botte zones I and II From University Medical Center Hamburg-Eppendorf, Hamburg, Germany Cite this article: Bone Joint Res 2026;15(1): 16–24. DOI: 10. 1302/2046-3758 . 151.BJR-2025-0238.R1 Correspondence should be sent to Tim Rolvien t. rolvien@ [uke.de](uke.de) L. Krüger,1 A. Hedar,1 T. Spethmann,2 B. Ondruschka,3 F. T. Beil,1,4 F. von Brackel,5 A. Simon,1,5 T. Rolvien1 1Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 2Institute of Anatomy and Experimental Morphology, University Medical Center HamburgEppendorf, Hamburg, Germany 3Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 4Helios ENDO-Klinik Hamburg, Hamburg, Germany 5Department of Osteology and Biomechanics, University Medical Center HamburgEppendorf, Hamburg, Germany Aims The optimal treatment of proximal fifth metatarsal (MT-V) fractures remains controversial. The most commonly used classification according to Lawrence and Botte distinguishes between three fracture types (zone I to III, from proximal to distal), aiming to derive the healing potential and treatment recommendations. It has been proposed that certain fracture types, such as zone II fractures, should be allocated to zone I and therefore treated conservatively rather than surgically based on their healing potential. Accordingly, this work aims to investigate the osseous microarchitecture in the three different zones ofthe proximal MT-V as a morphological basis for fracture classification. Methods A total of 30 bilateral MT-V bones were obtained from 15 skeletally intact body donors. The zone-specific, trabecular, and cortical microarchitecture at the MT-V base was analyzed by high-resolution peripheral quantitative CT (HR-pQCT) . Differences between zones I, II, and III were analyzed using group comparisons and the influence of possible demographic factors using linear regression analyses. Results A decrease in trabecular bone microarchitecture with a simultaneous increase in cortical parameters was observed from zones I to III. Both trabecular and cortical parameters showed greater structural similarity between zones I and II than between zones II and III. Specifically, trabecular bone mineral density, area, and bone volume fraction, as well as cortical bone mineral density and cortical thickness, all exhibited smaller mean differences between zones I and II than between zones II and III. Female sex and advanced age were risk factors for poor microarchitecture in all three zones. Conclusion Our observations support the assumption that, due to the closer microstructural similarity, zone II fractures might have a similarly good healing potential as zone I fractures. The observed deterioration of microarchitecture in women and the elderly might indicate an increased susceptibility to fracture in this patient group. Article focus • Analysis of zone-specific bone microarchitecture of the proximal fifth metatarsal using high-resolution peripheal quantitative CT (HR-pQCT) . • The possible influence of demographic factors such as age, sex, and BMI on the microstructure of the proximal fifth metatarsal. Key messages • Lawrence and Botte zone II shows greater microstructural similarity to zone I than to zone III. • Female sex and advanced age are risk factors for poor bone microarchitecture in all zones. Strengths and limitations • This is the first study presenting the microarchitecture of the proximal fifth metatarsal. • Due to the nature of body donation, the patients were of advanced age, which represents a possible limitation. Introduction Metatarsal fractures are among the most common fractures of the foot and ankle, occurring at an incidence of approximately 15.6/100,000 people.1 Of these, the

FAQs

What question does the study investigate about Lawrence and Botte fracture zones?

It tests whether the osseous microarchitecture differs across zone I, II, and III and whether zone II might share a healing potential closer to zone I rather than zone III.

How were bone microarchitecture differences measured?

Zone-specific trabecular and cortical microarchitecture at the MT-V base was analyzed using high-resolution peripheral quantitative CT (HR-pQCT) and compared across zones with group comparisons and linear regression.

What did the study find when comparing zones I, II, and III?

Trabecular parameters decreased while cortical parameters increased from zones I to III. Structural similarity was greater between zones I and II than between zones II and III, with smaller mean differences in key trabecular and cortical measures between zones I and II.

Sep 29, 2026

Uploaded by Bulrr