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Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal

2016; British Editorial Society of Bone & Joint Surgery; Volume: 98-B; Issue: 6 Linguagem: Inglês

10.1302/0301-620x.98b6.36329

2049-4408

Pavel Akimau, K Cawthron, W. M. Dakin, Carolyn Chadwick, Christopher M. Blundell, Mark B. Davies,

Sports injuries and prevention

The purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast. Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior.A total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed.At four weeks and six months, symptomatic treatment proved non-inferior in terms of primary outcome.Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. Significant loss to follow-up with this injury could be expected in longer term. Cite this article: Bone Joint J 2016;98-B:806-11.