The search strategy can be reviewed in the supplementary materials 2. Studies from the earliest record (June 1902), until January 2019 were retrieved from EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. The study protocol was prospectively registered in the PROSPERO registry for systematic reviews with registry number: CRD42019122682. The preferred reporting items for systematic reviews and meta-analyses statement (PRISMA) was used as a guideline for the present study. The clinical utility of this work is aimed at providing better guidance for clinicians and patients during the shared decision making process. A secondary aim of this study was to evaluate the clinical and return to activity related outcomes of each treatment strategy. The first aim of this review was therefore to assess available literature to determine the bone healing outcomes following both surgical and conservative treatment of each anatomical zone of acute proximal fifth metatarsal fractures. Even though controversy persists, the current trend in orthopaedic care has been to treat non-displaced zone 1 fractures primarily conservatively, to treat significantly displaced zone 1 fractures surgically, and to treat zone 2 and 3 fractures either conservatively or surgically depending on overall patient expectation and activity level. Fractures of the proximal fifth metatarsal have been subdivided into three regions, as described by Lawrence and Botte : tuberosity avulsion fractures (zone 1), Jones’ fractures (zone 2) and, proximal diaphyseal fractures (zone 3). Currently, the choice between surgical or conservative treatment of these fractures is primarily based on anatomical location and degree of fracture displacement. Level of evidenceĪcute fractures of the proximal fifth metatarsal are a common injury of the foot. Further research of proximal fifth metatarsal fractures is warranted to provide more definitive conclusions, but current findings can aid surgeons during the shared clinical decision making process. The outcomes of acute zone 3 fractures are rarely reported in the literature, so treatment recommendations remain unclear. In contradistinction, acute zone 2 fractures demonstrate higher union rates and faster time to union when treated surgically. ConclusionĪcute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. Only ten proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks. For Jones’ (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively. Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases. 627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment. Thirty-two articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method. All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. MethodsĪ literature search was performed to identify studies published from the earliest record to January 2019 using EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. To compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |