Support bandaging is best for avulsion fractures of the base of the fifth metatarsal
- Report By: Bruce Martin - Clinical Fellow
- Search checked by Kevin Mackway-Jones - Consultant
- Institution: Manchester Royal Infirmary
- Current web editor: Minnie Alexander - Senior Information Officer
- Date Submitted: 1st March 2000
- Date Completed: 30th June 2000
- Last Modified: 11th April 2001
-
Status:
Green (complete)
Three Part Question
In [an adult with an avulsion fracture at the base of the fifth metatarsal] is [immobilisation in a below knee cast better than simple support bandaging] in [controlling symptoms and speeding time to functional recovery]?Clinical Scenario
A 38 year old woman presents to the emergency department following an inversion injury of the right ankle. Clinical examination and x-ray confirm that there is an avulsion fracture at the base of the fifth metatarsal. You wonder whether immobilisation in a plaster cast is better than simple support bandaging.Search Strategy
Medline 1966-12/98 using the OVID interface.[{metatars$.mp AND fifth.mp} AND {exp fractures OR fracture$.mp}] LIMIT to human and english language.
Search Outcome
82 papers found of which 77 were irrelevant to the study question and 4 were of insufficient quality for inclusion.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Wiener BD et al 1997 USA | 89 consecutive patients with avulsion fractures of the base of the fifth metatarsal. Short leg cast vs soft (Jones) dressing Followed at 2, 4, 8 and 12 weeks. | PRCT | Time in support | No significant difference | No power study. Not blinded. 33% drop out rate |
| Modified foot score (pain, gait, function, walking distance) | No significant difference | ||||
| Time to full activity | Significantly shorter in soft dressing group 33 vs 46 days (p < 0.05) | ||||
| Time to bony healing | No significant difference |
Comment(s)
This is the only trial identified in this area and it has a number of weaknesses. Further well designed and executed studies are warranted.Clinical Bottom Line
On current evidence simple support bandages are the treatment of choice.References
- Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot & Ankle International 1997;18(5):267-269.