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

Abstract

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.

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

“…The preferable method is probably functional bandage with the support of a flat hard-soled shoe for 4 weeks, even if cast treatment is not contraindicated. To support our data, recently Akimau, et al 31 concluded that cast immo bilisation of avulsion fractures of the 5MTB in adults provides no benefit over symptomatic treatment with elastic bandaging in shorter and longer times. Vorlat, et al 36 reported that the most significant predicting factor of a poor functional outcome of these injuries was a prolonged period of non-weight-bearing.…”

Comparative study of surgical and conservative treatments for fifth metatarsal base avulsion fractures (type I) in young adults or athletes

“…Then patients were allowed for partial weight bearing with walker boot and crutch for a minimum of 3 months postoperatively. 19…”

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

“…Various studies have compared symptomatic treatment with cast immobilization in tuberosity fractures of the proximal fifth metatarsal with no significant differences between both. 1,8,19,21 The present study, however, investigated and compared the functional, clinical, and radiologic outcomes between both treatments. Moreover, we prospectively evaluated and compared patients’ ankle strength using isokinetic testing while also investigating the effects of fracture displacement during functional and isokinetic testing.…”

“…In their study, patients managed using walking boots exhibited improved combined pain levels and function 3 weeks earlier (ie, 9 weeks postinjury). Akimau et al 1 compared elasticated bandages and short leg casts using VAS-FA scoring, subsequently showing no significant differences between the 2 treatment methods. In their study, no significant differences in EuroQol-5D scores, which were also used to determine functional outcomes, were observed between both groups.…”