Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base.

Abstract

BACKGROUND:

This study assessed the clinical and radiological outcomes of different non-surgical interventions, surgical versus non-surgical interventions, and different surgical interventions used in the management of proximal fifth metatarsal fractures.

METHODS:

A systematic review of published and unpublished literature was undertaken.

RESULTS:

Six studies, assessing 330 patients and 333 fractures of the proximal fifth metatarsal were reviewed. Four studies assessed outcomes following tuberosity fractures, whilst 2 studies recruited patients following proximal diaphyseal or Jones fractures. The findings suggested that bandage is superior to below knee cast immobilisation for patient-reported functional and pain scores, with no difference in fracture union or re-fracture, and a shorter duration to return to work. There was no significant difference in complication rates or functional outcomes for patients managed in a plaster slipper compared to a bandage post-injury. When comparing surgical and non-surgical management, intramedullary screw fixation results in a shorter time to fracture union, reduced complication rates and earlier return to pre-injury activities compared to non-surgical cast immobilisation. However, the evidence-base is limited in it size and presented with a number of methodological limitations.

CONCLUSIONS:

Further well-conducted randomised controlled trials are required to determine the optimal management strategy for the different types of proximal fifth metatarsal fractures.

• Authors: T O Smith, A Clark, C B Hing
• Journal: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons (Foot Ankle Surg) Vol. 17 Issue 4 Pg. 300-7 (Dec 2011) ISSN: 1460-9584 [Electronic] France
• PMID: 22017907 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Topics

• Evidence-Based Medicine
• Fractures, Bone (therapy)
• Humans
• Metatarsal Bones (injuries)