Isokinetic Strength Comparison of Tuberosity Fractures of the Proximal Fifth Metatarsal Treated With Elastic Bandage vs Cast

Abstract

Background: The aim of this study was to compare the strength of injured and healthy ankle muscle as well as functional and clinical outcomes between patients with proximal fifth metatarsal tuberosity fractures who received elastic bandage treatment and those who received cast immobilization. Methods: Sixty-five patients who presented to our clinic between February 2018 and April 2019 were randomly divided into 2 groups: 33 received elastic bandages (group 1) and 32 received cast immobilization (group 2). All patients were scheduled for follow-up appointments at our clinic after 2, 4, 8, 12, and 24 weeks. Visual analog scale–foot and ankle (VAS-FA) score, time missed from work, and using assistive devices were recorded as clinical outcomes. Both ankle plantarflexion-dorsiflexion and inversion-eversion muscle strengths (peak torque) were measured using an isokinetic dynamometer for each group and were compared with those of the healthy extremities. Results: The mean missed work was 11.3 days in group 1 and 27.6 days in group 2. Groups 1 and 2 used assistive devices for a mean of 6.7 and 16.2 days, respectively ( P = .001). Group 1 had a significantly higher VAS-FA score at the 2nd, 4th, and 8th week of follow-up compared with group 2, and no significant differences were observed at the time of injury and at the 12th and 24th weeks. The muscle strength deficits in group 1 were present at the 4th week, whereas those in the cast immobilization group were determined at the 4th and 8th weeks in all muscles. During the 12th and 24th week of follow-up, no significantly differences in both extremities were observed between the groups. Conclusion: Elastic bandage treatment was better than cast immobilization in terms of preserving ankle muscle strength, clinical outcomes, and functional scores regardless of the degree of fracture displacement. Moreover, the present study emphasized that cast immobilization offered no advantages in this fracture treatment. Level of Evidence: Level I, prognostic randomized controlled trial.

Outcomes comparison of elastic bandage versus lower-leg cast immobilization after anterior talofibular ligament repair

“…Some orthopedic surgeons suggested that the ideal rehabilitation regime after ATFL repair surgery was lower-leg cast for 1 or 2 weeks, followed by 2–4 weeks in a walking boot [ 9 ], whereas other people revealed that a compressive bandage and walker boot in neutral position were used for the first 2 weeks with no weight bearing [ 10 ]. Serkan et al reported that elastic bandage treatment was superior to cast immobilization in terms of preserving ankle muscle strength, clinical outcomes, and functional scores in treating tuberosity fractures [ 11 ]. However, similar studies in CAI patients after arthroscopic ATFL repair are yet to be conducted.…”

“…Karlsson score is a relatively more comprehensive scoring scale for evaluation of ankle joint function, overlapping pain, swelling, instability, stiffness, stair climbing, running, work activities and support—8 parts of ankle function [ 18 ]. Bayram et al reported elastic bandage treatment was better than cast immobilization in terms of preserving ankle muscle strength, clinical outcomes, and functional scores [ 11 ]. Our study found that elastic bandage group had a significant higher Karlsson score at 6 months follow-up than lower-leg cast group and, while no significant difference at 12 months follow-up.…”

“…The AOFAS is one scoring system used to assess and monitor the progress of patients after foot and ankle surgery, with 40% scores indicates pain symptom [16]. Similarly, Bayram et al found that elastic bandage treatment was better than cast immobilization in terms of alleviating pain symptoms [11]. Akimau et al compared elasticated bandages and short leg casts using VAS scoring, subsequently showing no significant differences between the 2 treatment methods [17].…”

What’s New in Orthopaedic Trauma

“…"Less [immobilization] is more" seems to be the answer for the treatment of a Zone-1 proximal fifth metatarsal tuberosity fracture. In an RCT, 65 patients were treated with conservative measures 25 . Thirty-three patients were randomized to treatment with elastic bandages, and 32 patients received cast immobilization for 4 weeks.…”