Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature. (June 2020)

• Record Type: Journal Article
• Authors: Morgan, Catrin; Abbasian, Ali
• Is Part Of: Foot. Volume 43(2020)
• Publication Date: 2020-06
• Subjects: Dancer's fracture -- Fifth metatarsal -- Metatarsal fractures -- Outcomes -- Non-surgical management; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2019.101654
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: There is a paucity of literature when it comes to fifth metatarsal diaphyseal fractures. There is a bimodal distribution of age of presentation of this fracture. Non-surgical management results in excellent functional outcome regardless of initial displacement. This is the first study to report on outcomes of non-operative measures. A hard soled shoe is our preferred mode of immobilisation with excellent patient satisfaction and functional outcomes. Abstract: Introduction: Spiral diaphyseal fractures of the fifth metatarsal can present with significant displacement. It is considered that non-operative management is sufficient in most cases but there is no clear consensus as to what this may be. This study reports the functional outcome of this injury in a small patient cohort and is the first study to report on outcomes of different non-operative measures. Material and methods: This is a retrospective study of 33 consecutive patients presenting to a central London teaching hospital who were managed by a variety of treatment modalities depending on surgeon preference which included a boot or a rigid sole shoe. Demographic data was obtained and time to pain free walking and return to normal footwear was recorded. The patients were asked how restrictive the injury was on a Likert scale (1–5). The average final follow up was 12 months. Results: All fractures were managed conservatively with excellent functional outcomes. Those patients managed in a shoe had a statistically significant shorter average time to return to pain free walking (4.6 vs 8.4 weeks, p = 0.027) and average time to return to normal footwear (6 vs 7.3 weeks, p = 0.044) in comparison to a boot. Patients managed in a shoe reported the injury was less restrictive in comparison to patients managed in a boot (p = 0.0002). The average time to evidence of bony union was 8.3 weeks. There were 3 delayed unions. Conclusion: All patient in this series were treated without surgery regardless of the degree of displacement. Conservative management of this fracture in a rigid sole shoe resulted in better outcomes and was reported to be less restrictive by the patients in comparison to a boot. On this basis, non-surgical management of these injuries is recommended in a shoe, full weight bearing with early range of movement of the ankle.