Results of Functional Treatment of Epi-Metaphyseal Fractures of the Base of the Fifth Metatarsal

Abstract

Background: Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT. Methods: This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years. Results: For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed. Conclusion: Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs. Level of Evidence: Level III, comparative study.

Functional outcome of 103 fractures of the proximal fifth metatarsal bone

“…The functional outcome of L&B type I fractures was satisfactory with a median FAOS score of 91 following a nonoperative treatment ( n = 10). This is in accordance with other studies advocating a conservative treatment for this fracture type to the proximal fifth metatarsal bone [ 12 , 18 , 19 ]. Outcome was assessed with the Visual Analogue Scale Foot and Ankle Questionnaire (VAS FA) and reported as good to excellent following conservative treatment [ 19 , 20 ].…”

“…In the analyzed study age did not affect the functional outcome, which is in line with previous published studies showing no significant influence of patient age on the functional outcome [ 12 , 13 , 26 ].…”

“…Comparing the 1 year results of Shahid et al with the presented findings, the long-term outcome after conservative treatment seems to be independent of the treatment protocol [ 20 ]. The advantage of a functional treatment with full weight bearing is an early-return-to-work and can be satisfactory employed, independent of displacement, articular involvement and comminution [ 11 , 12 ].…”

“…In the analyzed patient cohort conservative management (FAOS = 91) was equivalent in comparison to operative treatment (FAOS = 89) regarding the functional score. Despite some studies supporting surgery in these kind of fractures [ 14 , 15 , 22 ], there is growing evidence in the literature that conservative treatment results in excellent functional outcome [ 12 , 13 , 23 ]. The discrepancies might be due to inconsistent definition of fracture types among the studies since exact fracture location is decisive for prognosis.…”

Fifth metatarsal fractures: an update on management, complications, and outcomes

“…Conservative or surgical treatment is decided based on the fracture type, associated injuries, and individual patient characteristics. There is a plethora of non-operative treatment modalities, including elastic bandage support, non-weight-bearing casting, a hard-soled shoe, short-leg walking casts, and a cam walker boot (47,48,49,50,51,52). Various surgical techniques exist, with intramedullary screw fixation (6,13,36,53,54,55,56,57,58,59) with or without bone grafting, tension band constructs (60), and low-profile plates (61,62,63,64,65,66,67).…”