Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature
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…
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