%0 Journal Article
%T Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature.
%A Morgan C
%A Abbasian A
%J Foot (Edinb)
%V 43
%N 0
%D Jun 2020
%M 32086137
暂无%R 10.1016/j.foot.2019.101654
%X BACKGROUND: 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.
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.
CONCLUSIONS: 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.