![]() (1992), the presence of an avascular zone in the proximal-diaphysis after a fracture (disrupted supply from the nutrient artery) could affect the decision-making process concerning the choice of intervention because of its influence on the prognostic outcome of the fracture.ĭespite the advancements in the past decades concerning development of various interventions, and anatomical specifications, a consensus concerning an optimal choice of intervention for managing fifth metatarsal’s base fracture is still missing. Besides, another important aspect that requires due diligence on the behalf of the clinician for selecting an appropriate intervention is the vasculature of the fracture site. The classification suggests that the presence/absence of medullary sclerosis on the fracture margins could substantially influence the prognostic outcomes associated with the choice of intervention. The most widely used of them, the Torg classification, distinguishes the fracture in three different subtypes based on their healing potential. The choice of strategy to be utilized, however, is usually inclined upon the various classifications of fracture reported in the literature. Whereas, the non-operative measure employs an immobilization cast aimed to facilitate passive healing with/without weight-bearing. The operative measures usually include an internal fixation approach with an intramedullary, bicortical screw and/or bone graft-inlay. ![]() Typically, the management of the fifth metatarsal’s base fracture has been pursued by either operative, or non-operative measures. Secondly, a higher correlation between metatarsal fractures and lower levels of bone mineral density as in osteoporotic, and post-menopausal women, is an additional reason due to which this fracture is common in senile population groups. Firstly, the biomechanical insufficiency of the fifth metatarsal during inverse axial-loading at the ankle joint has been suggested to be a predominant reason predisposing towards this stress fracture. Literature suggests many reasons which could be behind the higher prevalence of this fracture across different population groups. Moreover, studies report that the onset of this fracture at the fifth metatarsal’s base is highly prevalent in both sports, and sedentary settings. According to the recent epidemiological studies, this fracture accounts for almost 40–75% of all fractures encountered at the foot. The fracture is characterized by a transverse disruption at the diaphyseal and metaphyseal junction of the proximal 1/3 rd of the metatarsal bone. The review reports beneficial effects of operative interventions as compared to non-operative interventions for reducing the rate of non-union, duration of union, duration of return to activity, duration of return to sport, visual analog scale, and increasing the American orthopedic foot & ankle scale score.įracture of the fifth metatarsal’s base is one of the most common stress fractures encountered in the lower extremities. ![]() The current systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal’s base fracture. The meta-analysis reveals beneficial effects for operative interventions by demonstrating medium to large effect reduction of rate of non-union (Hedge’s g: -0.66), duration of union (-1.7), duration of return to activity (-2.07), visual analog scale (-0.86), and enhancement of the American orthopedic foot & ankle scale score (0.73) as compared to non-operative intervention. This systematic review presents a 1b level of evidence supporting the use of operative interventions for enhancing fracture union as compared to non-operative interventions. Out of 1,170 records, 11 articles including 404 participants (mean age: 29.8 ± 7.4 years) were included in this review. A meta-analysis evaluated the influence of operative and non-operative interventions on rate of non-union, mean duration of union, duration of return to activity, duration of return to sport, visual analog scale, and the American orthopedic foot & ankle scale. ![]() A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. To meta-statistically compare the effects of operative and non-operative management of fifth metatarsal base fracture. However, to date, no attempt has been made to synthesize the evidence comparing the efficacy of operative and non-operative interventions for managing the fifth metatarsal’s base fracture. Studies have for long debated the use of operative and non-operative interventions for the management of the fracture, especially owing to its peculiar vasculature. Fracture to fifth metatarsal’s base is one the most common injury experienced at the foot. ![]()
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