5th metatarsal fractures; who do we actually need to see? A single centre experience

J. Chapman, Z. Choudhury, S. Gupta, G. Airey, T. Davies, L. Mason

Introduction: 5th metatarsal fractures are a common injury of the foot, however the literature on how to manage them is conflicting. Our department protocol states Zone 3 fractures should have face-to-face review, with other zones planned for discharged following virtual review. We sought to investigate whether our practice was consistent and the burden of 5th metatarsal fractures on our clinics.

Methods: Patients referred to our virtual fracture clinic (VFC) with a suspected or confirmed 5th metatarsal fracture were identified from our electronic database. Data was collected on VFC outcomes including telephone review, clinic reviews and requirement of surgery. Plain AP radiographs were reviewed for fracture morphology. Fractures were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft, distal metaphysis and head. A univariate linear regression model was used (SPSS v.27).

Results: 1391 patients were identified. 447 (32.1%) were planned for clinical review following VFC, however 568 (40.8%) were sent clinic appointments (McNemar p1 clinic appointment and requiring surgery (OR 3.895, p=.037). Surgery was required in only 1.1% of patients, with 60% of these for non-union.

Conclusions: Fractures of Z2 and 3 require the most face-to-face input. Whilst rare, Z3 is the most likely to require surgery, often for non-union. Based on these results, all Z2 and 3 fractures should be considered for at least one face-to-face review and it may be appropriate for this to be delayed.