Fifth metatarsal fractures: is routine follow-up necessary?

K.B. Ferguson, J. McGlynn, C. Kumar, N.J. Madeley, L. Rymaszewski

Introduction: Fifth metatarsal fractures are common and the majority unite regardless of treatment. A sub-type of these fractures carries a risk of non-union and for this reason many centres follow up all 5th metatarsal fractures. In 2011, a standardised protocol was introduced to promote weight-bearing as tolerated with either a tubigrip or Velcro boot. No routine fracture clinic appointments were made from A&E but patients were provided with information and a help-line number to access care if required. Some patients still attended fracture clinics, but only after review of their notes/X-rays by an Orthopaedic Consultant, or after self-reported “failure to progress” using the special help-line number.

Methods: Audit of a year prior to the introduction of the protocol and the year following it was performed. Patient satisfaction surveys sent at 1 year.

Results: During 2009/2010, 279 patients presented to A&E with a 5th metatarsal fracture and were referred to a fracture clinic. 106(38%) attended 1 appointment, 130(47%) attended 2 appointments and 31 (11%) attended 3 or more appointments - 491 appointments in total. 3% failed to attend the clinic. Operative fixation was performed in 3 patients (1.07%). In 2011/2012, of 339 A&E fractures, only 67 (20%) attended fracture clinic. 38 (11%) attended 1 appointment, 14 (4%) 2 and 9 (3%) 3 or more appointments - 102 appointments in total. 5 patients (1%) required operative fixation.

Conclusion: Our study did not demonstrate any added value for routine outpatient follow-up of 5th metatarsal fractures. Patients can be safely allowed to weight bear and discharged at the time of initial presentation in the A&E department if they are provided with appropriate information and access to a “help line” run by experienced fracture clinic staff. The result is a more efficient, patient- centred service. 77% of surveyed patients were satisfied with the service.