Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast vs functional bandage

Abstract

SummaryBackground: The purpose of this non-randomized retrospective study was to investigate outcomes of minimally displaced, proximal 5MTB fractures, treated by a below-knee walking cast or a functional elasticated bandage with a support of a flat hardsoled shoe. Methods: A consecutive patient series was divided into two groups: the cast group (CG) and the functional group (FG). The subjects were radiologically and clinically evaluated according to Mehlhorn and Lawrence-Botte classification, and AOFAS Midfoot score, respectively. Results: 154 patients were followed up for a median of 15 months (range 12-24). There was no significant difference (p > 0.05) among the outcomes of each fracture pattern regarding the treatment choice.However, an earlier return to sports was noted in the FG, while Type-3 fractures achieved the worst results. Conclusion: Type-1 and 2 minimally displaced 5MTB proximal fractures can be successfully treated conservatively without weight-bearing restriction and without benefit of a cast with respect to a functional elasticated bandage. Level of clinical evidence: level III retrospective comparative study.

Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

“…Zone 3 fractures are generally considered stress fractures that can be treated both surgically and conservatively [ 7 , 10 , 25 , 35 , 38 , 40 ]. Only one case series of acute fractures was found with comparable outcomes of conservative treatment for zone 1 and 2 [ 4 ]. However, case reports by Zelko et al [ 57 ] and Arangio et al [ 2 ] reported varying results of their primarily surgically treated patients.…”

“…For zone 1, 711 fractures were included from 19 studies [ 1 , 3 , 4 , 6 , 11 – 13 , 15 , 23 , 25 , 26 , 32 , 37 , 45 , 50 , 52 – 54 , 58 ], of which 531 (74.7%) fractures were managed conservatively and 180 (25.3%) were managed surgically. Conservatively treated fractures were non-displaced in 267 (50.3%) cases, displaced in 77 (14.5%) cases, and unrecorded for 187 (35.1%) cases.…”

“…Ten acute zone 3 fractures from a single case series were found through the literature search (also see supplementary materials 1), with the patients having a mean age of 57 years and follow-up of 15 months (range 12–24) [ 4 ]. Individual study characteristics can be viewed in the supplementary materials 1.…”

What Is the Interrater and Intrarater Reliability of the Lawrence and Botte Classification System of Fifth Metatarsal Base Fractures?

“…There are numerous studies supporting the operative treatment of Zone 3 stress fractures [4, 14, 20, 21]. Zone 2 fractures have been less thoroughly described and evaluated; several studies have demonstrated a high likelihood of union with nonoperative treatment [1, 2, 4, 15], whereas others advocate operative treatment because of faster healing [4], a higher likelihood of union [8, 11], and lower risk of refracture [22].…”

Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes

“…Although none of their patients was a professional athlete, only half of zone 3 showed radiologic consolidation and took 20-22 weeks to return to sports activity. 28 This means some patients could achieve sufficient bone strength to endure the intensity and duration of the preinjury level activity after conservative treatment. However, about 4 months was required to return to their previous sports activity level.…”