Isolated osteochondral fracture of the metatarsal head of lesser toes

• Isolated fracture of the metatarsal head is very rare.
• The X-rays appearance can be subtle and computed tomogram is useful in case of uncertain diagnosis.
• The fracture was consistent with shear force by the proximal phalanx on the metatarsal head.
• The optimal treatment of this fracture had not been established.
• The greatest prognostic indicator for this fracture type is the ability to adequately reduce the joint surface.

Isolated fracture of the metatarsal head is very rare and no consensus has been reached regarding their best management. We reported four cases of isolated osteochondral fracture of the metatarsal head with different method of treatment to achieve the common goal of restoration of the congruity of the metatarsal head.