Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug;46(8):1664-8.
doi: 10.1016/j.injury.2015.05.041. Epub 2015 May 27.

Fifth metatarsal fractures - Is routine follow-up necessary?

K B Ferguson  1 , J McGlynn  2 , P Jenkins  2 , N J Madeley  2 , C S Kumar  2 , L Rymaszewski  2
Affiliations

Fifth metatarsal fractures - Is routine follow-up necessary?

K B Ferguson et al. Injury. 2015 Aug.

Abstract

Background: Fifth metatarsal fractures are common, and the outcome with conservative treatment is generally very satisfactory. Operative treatment is only used for selected injuries, particularly stress fractures. Traditionally these patients are routinely reviewed at a fracture clinic, mainly due to the perceived risk of non-union with a Jones' fracture. In 2011 we introduced a standardised protocol to promote weight bearing as pain allowed with an elasticated support or a removable boot. Patients were discharged with structured advice and a help-line number to access care if required, but no further face-to-face review was arranged. More complex cases were reviewed at a "virtual clinic." Our hypothesis was that the introduction of this standardised protocol would be safe, patient-centred and significantly reduce unnecessary outpatient clinic review.

Patients and methods: We audited fracture clinic attendance and outcomes 1 year before and 1 year after the protocol was introduced in 2011. All radiographs taken at the Emergency Department (ED) presentation were reviewed and classified independently for validation.

Results: From 2009 to 2010, 279 patients who presented to the ED with fifth metatarsal fractures were referred to a fracture clinic. Of these 279 patients, 267 (96%) attended the fracture clinic, resulting in an overall total of 491 outpatient attendances. Three (1%) were treated operatively for delayed/non-union. From 2011 to 2012, 339 patients presented to the ED with fifth metatarsal fractures - only 67 (20%) were referred to a fracture clinic. 62 (18%) attended clinic appointments with 102 appointments in total. Five (1%) required operative intervention.

Conclusion: Our study showed no added clinical value for routine outpatient follow-up of fifth metatarsal fractures. Patients can be safely discharged and allowed to bear weight at the time of initial ED presentation if they are provided with appropriate information and ready access to experienced fracture clinic staff.

Keywords: Fifth metatarsal fracture; Metatarsal fracture; Virtual clinic.

PubMed Disclaimer