Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

Vorlat, Peter; Achtergael, Wim; Haentjens, Patrick

doi:10.1007/s00264-006-0116-9

Cited by 65 publications

(36 citation statements)

References 18 publications

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“…There are many descriptions of the types of fracture that affect the proximal end of the fifth metatarsal, but it seems clear that, with the exception of a true Jones fracture, the type of fracture has no influence on functional outcome. 9,17,[20][21][22] Most unite within eight weeks: those that do not are often asymptomatic. 23 Vorlat, Achtergael and Haentjens 22 reported that the most significant predictor of a poor functional outcome after these injuries was a prolonged period of non-weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

“…9,17,[20][21][22] Most unite within eight weeks: those that do not are often asymptomatic. 23 Vorlat, Achtergael and Haentjens 22 reported that the most significant predictor of a poor functional outcome after these injuries was a prolonged period of non-weight-bearing. Despite a general acceptance that non-operative treatment gives a high rate of patient satisfaction, evidence about the best form of nonoperative treatment is scant.…”

Section: Discussionmentioning

confidence: 99%

“…3,15,16,24 There is, however, no evidence that this is so. 9,17,[20][21][22] Many authors, in fact, suggest that nonoperative management gives an acceptable outcome and return to function. 3,12,13 The problem with some studies which advocate non-operative treatment is the lack of a comparative treatment group.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Akimau

Cawthron

Dakin

et al. 2016

The Bone & Joint Journal

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AimsThe purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast.Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior. Patients and MethodsA total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed. ResultsAt four weeks and six months, symptomatic treatment proved non-inferior in terms of primary outcome. Take home message:Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. Significant loss to follow-up with this injury could be expected in longer term. Cite this article: BoneJoint J 2016;98-B:806-11.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Akimau

Cawthron

Dakin

et al. 2016

The Bone & Joint Journal

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“…A meta-analysis of 187 tuberosity avulsion fractures from four studies in 2011 showed that there was no significant difference in union and refracture rates between different conservative treatment modalities (17). However, studies have shown that functional treatments with early weight bearing provide better functional outcome and earlier return to work than treatment by short leg cast with non-weight bearing walking (18-21). Therefore, functional treatments with orthopedic shoe, Jones bandage dressing or elastic bandage dressing are recommended.…”

Section: Resultsmentioning

confidence: 99%

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Cheung¹,

Lui²

2016

Arch Trauma Res

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ContextFractures of proximal fifth metatarsal are one of the most common fractures of the foot.Evidence AcquisitionA search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.ResultsThe vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.ConclusionsLawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

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“…9 Although tuberosity avulsion fractures tend to heal with nonoperative management, numerous studies have shown that healing of meta-diaphyseal fractures is somewhat less predictable, especially in active individuals and highly competitive athletes. 5,8,10,13,23,24 To evaluate the outcomes of treatment of these injuries in highly competitive athletes, Low et al 10 identified 83 meta-diaphyseal fifth metatarsal fractures in football players participating in the National Football League (NFL) Scouting Combine between 1988 and 2002. Of the 46 fractures treated operatively, there were 3 nonunions (6.5%).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Peroneus Brevis Tendon Anatomy on the Stability of Fractures at the Fifth Metatarsal Base

et al. 2014

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Objectives:Fractures of the fifth metatarsal base are not uncommon. Both fracture management and outcomes can differ greatly depending on fracture location. The purpose of the present study is to evaluate the influence of the peroneus brevis (PB) tendon on proximal fifth metatarsal fracture stability. We hypothesize that proximal fifth metatarsal fractures distal to the PB tendon footprint are inherently less stable than more proximal fractures. Methods: We utilized 5 matched pairs of fresh-frozen cadaveric specimens. We carefully exposed the 5th metatarsal and PB tendon. We measured the length of the PB insertion at the base of the fifth metatarsal with calipers. The PB and Achilles tendons were then whip-stitched proximally to facilitate loading. A custom leg holder was fabricated to allow loading and fluoroscopic evaluation. Two conditions were utilized for biomechanical testing; (1) a simulated fracture distal to the PB insertion (Jones equivalent) and (2) a simulated fracture within the footprint of the PB insertion (avulsion equivalent). All fractures were carefully created with a narrow osteotome. Following fracture creation, the plantar flexed foot was statically loaded through the Achilles and PB tendons. Oblique images with and without loading and digital measurements were performed to evaluate for fracture separation. We utilized a paired student T test and intraclass correlation coefficient (ICC) for all statistical analysis. Results: The average length of the PB footprint was 15.2 mm. Compared to fractures within the PB footprint, fractures distal to the PB tendon insertion demonstrated greater fracture widening following loading of the PB tendon. Fractures within the PB footprint widened 0.4 mm on loading ( Figure 1A to 1B) compared to 1.1 mm of widening in the fractures distal to the PB insertion ( Figure 1C to 1D). This difference was significant (p = 0.02). Intraobserver reliability for all radiographic measurements showed substantial agreement. Conclusion: Avulsion fractures at the base of the fifth metatarsal have much better healing potential than the socalled Jones fracture. Poor vascularity has been cited as a cause for poor healing potential following Jones fractures. The principal findings of this study demonstrate that proximal fifth metatarsal fractures distal to the PB insertion are significantly more unstable than more proximal fractures. In our study, the PB exerts a deforming force on the proximal fragment of fractures distal to the PB footprint. This deforming force was less pronounced in fractures within the PB footprint. Our findings help support the notion that a mechanical component may contribute to the poor healing potential of Jones fractures secondary to deformation exerted by the PB tendon. This would help explain why screw fixation is often recommended to address Jones fractures. Further research is needed to evaluate the biomechanics of these fractures.

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Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

Cited by 65 publications

References 18 publications

Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

The Effect of Peroneus Brevis Tendon Anatomy on the Stability of Fractures at the Fifth Metatarsal Base

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