A prospective comparison of two treatment options for tuberosity fractures of the proximal fifth metatarsal

Gray, Andrew; Rooney, Brian; Ingram, Roland

doi:10.1016/j.foot.2008.02.002

Cited by 43 publications

(37 citation statements)

References 11 publications

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“…Demographically, these patients were similar to those in other series investigating metatarsal fractures in adults. 5,6,9,13 The VAS-FA scores are shown in Figure 3. In the symptomatic group, the non-inferiority boundary of -10 was not crossed at the baseline, four weeks or six months indicating that symptomatic treatment was not inferior.…”

Section: Resultsmentioning

confidence: 99%

“…A number of non-operative forms of treatment have been studied which range from elasticated bandaging and wearing a hard-soled shoe through to immobilisation in a cast, focused rigidity casting or a walking boot. 2,[4][5][6][7][8][9][10][11][12][13][14] Few authors recommend internal fixation. 3,15,16 Although some authors draw a distinction between the treatment of displaced and undisplaced fractures, others have noted no clear effect of the degree of comminution, the amount of displacement and the propagation of fracture into the fifth tarsometatarsal joint on the outcome of non-operative management.…”

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confidence: 99%

“…3,9,17 The limitations of previous studies, which compare non-operative treatments, include a lack of a comparative group; the inclusion of a heterogeneous group of metatarsal fractures; prospective randomised studies without power analyses and the use of non-validated outcome measures. [5][6][7]9 The aim of this study was to carry out a prospective, randomised, non-inferiority, controlled study to compare symptomatic treatment in a double-layered elasticated bandage with immobilisation in a below-knee cast. The rationale for this design of study is that it may offer an advantage in terms of cost, availability and outcome compared to a reference form of treatment.…”

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confidence: 99%

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Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Akimau

Cawthron

Dakin

et al. 2016

The Bone & Joint Journal

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AimsThe purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast.Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior. Patients and MethodsA total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed. ResultsAt four weeks and six months, symptomatic treatment proved non-inferior in terms of primary outcome. Take home message:Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. Significant loss to follow-up with this injury could be expected in longer term. Cite this article: BoneJoint J 2016;98-B:806-11.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Akimau

Cawthron

Dakin

et al. 2016

The Bone & Joint Journal

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“…A meta-analysis of 187 tuberosity avulsion fractures from four studies in 2011 showed that there was no significant difference in union and refracture rates between different conservative treatment modalities (17). However, studies have shown that functional treatments with early weight bearing provide better functional outcome and earlier return to work than treatment by short leg cast with non-weight bearing walking (18-21). Therefore, functional treatments with orthopedic shoe, Jones bandage dressing or elastic bandage dressing are recommended.…”

Section: Resultsmentioning

confidence: 99%

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Cheung¹,

Lui²

2016

Arch Trauma Res

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ContextFractures of proximal fifth metatarsal are one of the most common fractures of the foot.Evidence AcquisitionA search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.ResultsThe vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.ConclusionsLawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

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“…Torg type I diaphyseal stress fractures (zone three) are also managed the same however, prolonged immobilization up to twenty weeks may be required[3,10,13,31]. Despite prolonged immobilization zone three diaphyseal stress fractures may still go on to nonunion.…”

Section: Nonoperative Treatmentmentioning

confidence: 99%

Fifth metatarsal fractures and current treatment

Bowes

Buckley

2016

WJO

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Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literature on management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

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A prospective comparison of two treatment options for tuberosity fractures of the proximal fifth metatarsal

Cited by 43 publications

References 11 publications

Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Fifth metatarsal fractures and current treatment

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