Support bandaging is best for avulsion fractures of the base of the fifth metatarsal
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Bruce Martin, Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
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.
Search Details:
[{metatars$.mp AND fifth.mp} AND {exp fractures OR fracture$.mp}] LIMIT to human and english language.
Outcome:
82 papers found of which 77 were irrelevant to the study question and 4 were of insufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Treatment of fractures of the fifth metatarsal: a prospective study. Wiener BD, Linder JF, Giattini JF. 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 |
Author Commentary:
This is the only trial identified in this area and it has a number of weaknesses. Further well designed and executed studies are warranted.
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.