Outcome of avulsion fractures in the foot after supination trauma: A systematic review

Avulsion fractures of the foot after supination trauma are frequently encountered at the emergency department. Despite their high incidence, the prognosis of these fractures remains largely unknown. Moreover, evidence-based treatment recommendations are lacking and treatment decisions are primarily guided by expert-opinion. Our purpose is to provide an overview of the prognosis for these fractures.

A systematic review was performed using the Medline and Embase databases to search for studies that reported on clinical outcome ≥ 6 months after an avulsion fracture of the foot after supination trauma.

Seven avulsion fracture-types were identified and included in the search. Seventeen studies were included. Three studies focused on avulsion fractures of the anterior process of the calcaneus, and 14 focused on avulsion fractures of the base of the fifth metatarsal. Average number of cases was 41 (range 6-102). Average follow-up duration from fracture date was 22.6 months (range 6-206). Clinical outcome scores (AOFAS/Karlsson) indicated a favorable outcome for most patients of both fracture-types. However, both fracture-types had a subgroup with less favorable outcomes as all lower limits of the reported ranges were below normative.

Limited data is available on the clinical outcome (≥ 6 months) of fractures of the anterior process of the calcaneus and fifth metatarsal, both seem favorable. However, for both fracture-types there appears to be a subgroup with substantial persisting complaints. For 5 out of 7 avulsion fracture-types of the foot after supination there is insufficient data available in literature to provide patients with an adequate prognosis.

Therapeutic Level III, systematic review containing retrospective cohort studies.