SLR- February 2014- Eric C. Kissel
Reference: Aynardi M; Pedowitz DI; Saffel H; Piper C; Raikin SM. Outcome of Nonoperative Management of Displaced Oblique Spiral Fractures of the Fifth Metatarsal Shaft. Foot and Ankle International. 2013 Dec; 34(12):1619-1623.
Scientific Literature Review
Reviewed By: Erik C Kissel, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance: Metatarsal fractures are commonly seen in podiatric practice. This level II study on displaced, spiral oblique fifth metatarsal fractures provides validation for nonoperative treatment of these injuries.
Methods: The authors reviewed charts from their large private practice group for cases of metatarsal fractures over a five-year period. Closed, displaced, spiral fractures of the distal shaft of the fifth metatarsal (dancer's fractures) were selected for a total of 142 fractures. Patients with multiple fractures and those treated with ORIF were excluded. The senior authors confirmed all cases by radiographs. Patients were placed in a fracture boot or stiff-soled shoe and allowed to bear weight as tolerated for six weeks. They were then transitioned to regular shoegear if clinical and radiographic assessment demonstrated fracture healing. Follow-up data were available for 92 percent of patients. Final follow-up examination was performed at a minimum of two years post-injury; the average follow-up period was 3.5 years. Short Form-12 (SF-12) and Foot and Ankle Ability Measure (FAAM) outcome scores were obtained at follow-up.
Results: The FAAM activities of daily living and sports subscores averaged 95.5 and 92.7 (out of a maximum of100 points), respectively. SF-12 physical and mental subscores averaged 51.4 and 50.3, respectively. Two delayed unions occurred, and both healed uneventfully by six months. Three non-unions occurred; one was successfully treated nonoperatively with a bone stimulator, and the other two went on to ORIF augmented with calcaneal autograft. All three non-unions had excellent functional scores at follow-up.
Conclusions: With only 2 out of 141 (1.4 percent) patients failing nonoperative treatment, this study demonstrates that nonoperative treatment should be considered as a first line intervention for this fracture type. The authors do acknowledge that there are some cases where ORIF might be preferred, such as open or significantly displaced fractures.