Comparative outcomes of foot cast and short leg cast in pseudo‐Jones avulsion fracture: a single blinded randomized controlled trial

Abstract

Background Fractures of the metatarsal bones account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth metatarsal bone (pseudo-Jones) is by protected weight bearing. The methods of protected weight bearing include short-leg casting and splinting (boot cast, Jones’s bandage and elastic bandage). However, currently there is no consensus as to which method is the most suitable. Method We have conducted a randomized controlled trial to compare outcomes of foot casting (FC) and short leg casting (SLC) to assess pain, function and complication outcomes for the treatment of pseudo-jones metatarsal fractures. This single-center, single blind,randomized controlled trial was conducted between 1 June 2016–1 July 2018 at Police General Hospital, Bangkok, Thailand. Result A total of 72 pseudo-jones metatarsal fracture participants were randomly allocated to treatment by foot cast or short leg cast. The primary outcomes were pain VAS, AOFAS and complications measured at 2, 4, 6 and 8 weeks after receiving the treatment. Seventy-two patients (36 paticipants per group) were enrolled to receive either FC or SLC. The mean VAS measured at baseline, 2 weeks, 4 weeks, 6 weeks and 8 weeks were 7.36, 1.97, 0.58, 0.17 and 0.08 respectively in the FC group; and 6.09, 2.91, 1.23, 0.37 and 0.11 respectively in the SLC group. The mean AOFAS at baseline, 2, 4, 6 and 8 weeks were 33.60, 68.22, 82.72, 91.75 and 98.11 respectively in the FC group; and 32.60, 60.20, 70.20, 92.24 and 99.13 in the SLC group. The estimated mean difference of pain VAS and AOFAS at 2 weeks and 4 weeks were − 0.94 (95% CI: − 1.53, − 0.34), − 0.65 (95%CI: − 1.24, − 0.05), 8.02 (95%CI: 3.74, 12.10) and 12.52 (95%CI: 8.27, 16.78), which were statistically significantly better in the FC groups when compared to the SLC groups. However, there were no statistically significant difference between the two groups at 6 and 8 weeks. Conclusion This study demonstrated that the application of foot casting can improve pain VAS and AOFAS function at 2 and 4 weeks in the treatment of pseudo-jones metatarsal fractures when compared to short leg casting. However, at 6 and 8 weeks, there were no statistically significantly different between the two groups.

Effect of enhanced recovery after surgery in the managements of ankle fracture patients: A single-center retrospective cohort study

“…Stenquist et al suggest that patients with any medial tenderness were at signi cantly higher risk of unstable ankle fracture with instability [14]. Casting or orthosis application non-inferior to cast immobilization is recommended for stable ankle fractures [15][16][17][18]. Naumann et al suggested that 6 days would be a safe window for operation that can be used to plan and perform the nal operation [19].…”

Acute Fifth Metatarsal Tuberosity Fractures: A Systematic Review of Nonoperative Treatment

“…It is possible that bulky dressing may lead to a return to function more quickly than short leg casting, although a significant difference was not demonstrated in the two reviewed randomized trials. Furthermore, although there is more evidence supporting the short leg cast, a recent randomized control trial by Piyapittayanun et al (2019) suggests that an isolated foot cast may be appropriate, with no differences observed between the isolated foot and short leg cast at 6-and 8-week follow-up. 18 Despite the low complication rate of acute metatarsal fractures and the low frequency of nonoperative cases being converted to surgical intervention, there still may be need for referral to an orthopedic surgeon for initiation of treatment.…”

“…Furthermore, although there is more evidence supporting the short leg cast, a recent randomized control trial by Piyapittayanun et al (2019) suggests that an isolated foot cast may be appropriate, with no differences observed between the isolated foot and short leg cast at 6-and 8-week follow-up. 18 Despite the low complication rate of acute metatarsal fractures and the low frequency of nonoperative cases being converted to surgical intervention, there still may be need for referral to an orthopedic surgeon for initiation of treatment. In particular, orthopedic surgeons are comfortably able to rule out a true Jones fracture or atypical injuries that may be treated with an alternative approach.…”

“…It is possible that bulky dressing may lead to a return to function more quickly than short leg casting, although a significant difference was not demonstrated in the two reviewed randomized trials. Furthermore, although there is more evidence supporting the short leg cast, a recent randomized control trial by Piyapittayanun et al (2019) suggests that an isolated foot cast may be appropriate, with no differences observed between the isolated foot and short leg cast at 6‐ and 8‐week follow‐up 18 …”

“…The search strategy yielded a total of 1941 articles after removal of duplicates. Five hundred seventy-seven articles remained after title screening and 90 articles after abstract screening of which seven articles (four randomized controlled trials [15][16][17][18] three prospective cohort studies [19][20][21] ) met the inclusion criteria (Figure 2). Six of the studies evaluated only nonoperative treatment modalities, whereas a single trial evaluated cast versus percutaneous screw fixation.…”