SLR - March 2022 - Ross T. Groeschl
Reference: Herterich V, Baumbach SF, Kaiser A, Böcker W, Polzer H. Fifth Metatarsal Fracture-A Systematic Review of the Treatment of Fractures of the Base of the Fifth Metatarsal Bone. Dtsch Arztebl Int. 2021 Sep 6;118(35-36):587-594.Level of Evidence: Level 2
Scientific Literature Review
Reviewed By: Ross T. Groeschl, DPM
Residency Program: Grant Medical Center – Columbus, OH
Podiatric Relevance: Currently there is no standard for treatment of fifth metatarsal base fractures based on where the fracture is located. Zones have been described based on the Lawrence and Botte classification system, but current literature does not use uniform terminology to describe the location of fifth metatarsal base fracture. Due to this, there has been no consistent treatment recommendations for each type of fifth metatarsal base fracture based on location. The purpose of this review article was to develop evidence-based treatment recommendations for fractures of the base of the fifth metatarsal, based on a systematic review of the literature.
Methods: A systematic review of the literature was performed according to the PRISMA statement and PICOS model by searching in Pubmed, CINAHL, Scopus, EMBASE, CENTRAL from each databases’ inception until 05/07/2020. This was performed by two examiners using Covidence systematic review software. The Lawrence and Botte classification of fracture location was used to analyze the articles.
Results: A total of 17 articles met the inclusion criteria. Patient follow-up periods ranged from 2-53 months. The results were separated based on the location of the fracture using the Lawrence and Botte classification. For Zone 1 fractures, the literature showed that early functional therapy is recommended. This applies to displaced, intra-articular and comminuted fractures within this zone. Zone 2 type fractures had comparable results when comparing conservative and surgical treatments. Both return to full function and functional outcomes were equivocal. Surgical treatment for zone 3 fractures with screw fixation was significantly superior to conservative treatment and is recommended by the author.
Conclusions: This study was able to demonstrate viable treatment options for fifth metatarsal base fractures. Zones 1 and 3 had more definitive treatment options when it came to conservative versus surgical options. Zone 2 was not as clear as what the better option was. The vagueness in terminology used made defining which zone some fracture fell into difficult. In some studies included in the review, there was no clear differentiation based on a classification system. Also, various expressions such as tuberosity fracture and pseudo-Jones fracture were used to describe the types of fractures in some articles, also leading to ambiguity of location of the fracture. In conclusion, fifth metatarsal base fractures occurring in zones 1 and 2 showed very good results with early functional therapy. Zone 3 fractures that were treated surgically were clearly superior to conservative treatments. The author noted that these results are based on a few studies and that larger studies are need in the future to verify these results.