How are fifth metatarsal fractures managed by the virtual fracture clinic?

Abstract

Abstract Background: A fifth metatarsal fracture is a frequent type of fracture that is not classified during assessment. Aims: To analyse the patterns in management plans of patients that have presented with basal fifth metatarsal fractures to promote a change in the service provided. Materials and methods: Study of 270 patients conducted over a period of 19 months classified the fractures using Dameron-Lawrence-Bofte classification, the Torg classification and the Stewart classification. Their data was then identified for treatment, non-union and delayed union. Results: Out of the 270 patients that presented to the Virtual Fracture Clinic with fifth metatarsal fractures, 53.3% were basal fractures of the fifth metatarsal. Using the Dameron-Lawrence-Bofte classification it was found that 73.6% were Zone 1, 22.2% were Zone 2 and 4.2% were Zone 3. It is shown that there is a 57% chance of delayed union in Zone 1 and 43% likelihood in Zone 2, where the treatment period is longer than 12 weeks. The highest occurrence of non-union is in Zone 2 of 57%, 29% in Zone 1 and 14% in Zone 3. In this cohort, 4 patients required operative management, 3 of these were Zone 2 and 1 was Zone 1. Conclusion: Zone 1 and 3 fractures require conservative management and could be discharged routinely with advice that it could take up to 12 weeks to heal. However, Zone 2 fractures are more likely to need a surgical approach and thus should receive a follow up appointment at 6 weeks.