Fifth metatarsal fractures - Is routine follow-up necessary?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Evidence-Based Medicine

Background:

• Fifth metatarsal fractures are common, with conservative treatment yielding satisfactory outcomes.
• Traditional fracture clinic reviews may be excessive, particularly for Jones fractures, due to perceived non-union risks.
• A standardized protocol was implemented to promote early weight-bearing and reduce routine follow-up.

Purpose of the Study:

• To evaluate the safety and patient-centeredness of a new protocol for managing fifth metatarsal fractures.
• To determine if the protocol could significantly reduce unnecessary outpatient clinic reviews.
• To assess the impact on operative interventions for non-union or delayed union.

Main Methods:

• An audit of fracture clinic attendance and outcomes was conducted one year before and one year after protocol implementation.
• Radiographs from Emergency Department (ED) presentations were independently reviewed and classified.
• Patient management involved structured advice, a helpline, and optional "virtual clinic" review for complex cases.

Main Results:

• Pre-protocol: 96% of 279 patients attended fracture clinic (491 total attendances); 1% required surgery.
• Post-protocol: Only 20% of 339 patients were referred to fracture clinic, with 18% attending (102 total appointments); 1% required surgery.
• The protocol significantly reduced fracture clinic referrals and attendances without increasing operative interventions.

Conclusions:

• Routine outpatient follow-up offers no added clinical value for fifth metatarsal fractures.
• Patients can be safely discharged from the ED with weight-bearing instructions and access to staff support.
• This approach is safe, patient-centered, and efficient, optimizing resource utilization.