Functional outcome and risk of non-union for 5th metatarsal base fractures treated via a new virtual fracture clinic

E. Toner, P. McCaughey, C. Peace, R. Cassidy, O. Diamond

¹Royal Victoria Hospital Belfast, Trauma & Orthopaedics, Belfast, United Kingdom

Objectives: Treatment of 5^th Metatarsal Fractures via discharge direct from Virtual Fracture Clinic (VFC) has become common practice in the NHS. After introduction of a VFC in a regional trauma centre there was hesitancy to discharge Zone 2 and 3 injuries due to a fear of non-union rates.  We aim to assess the functional outcome and incidence of non-union in 5^th Metatarsal base fractures, exposed to 1-year of follow-up.

Methods: 194 consecutive patients who sustained a 5^th metatarsal fracture were referred to a VFC between 2019 to 2020 were included.  X-ray imaging was reviewed to classify which zone as per the Lawrence & Bottle classification the fracture occurred in and union on subsequent follow-up. Telephone follow up was used to measure patient functional outcomes (EQ-5D health questionnaire/ foot and ankle ability measure (FAAM) survey) and satisfaction with the VFC service.

Results: Off 194 patients’, 53 were zone 1, 99 were zone 2, and 42 were zone 3 fractures. 80 were discharged directly from VFC. 114 patients were offered at least one face to face clinic follow up. We found 6 (3.1%) patients had a clinical and radiological evidence of non-union. 4 non-unions in zone 2, and 2 in zone 3. No Zone 1 injuries were identified with a non-union. Ultimately only 2 patients came to having surgery for symptomatic non-union. 104 patients completed functional outcome surveys. 93.3% of patients were satisfied with their level of functioning and recovery from injury.

Conclusion: The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of patient's, with Zone 2 and 3 injuries, developing a symptomatic non-union. Functional outcome surveys provide further reassurance. This study would support direct discharge of Zone 1 injuries from VFC.

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