1135 Evaluation of Management of Fifth Metatarsal Fractures in University Hospitals of North Midlands Fracture Clinics from March to May 2021

Abstract

Abstract Aim The primary objective is to ascertain if fracture clinic follow-up of simple, isolated fifth metatarsal fractures is required, or if discharging patients from Accident & Emergency and Minor Injury Units with clinical advice and a contact number is a safe, cost-effective alternative. We also aim to design a protocol and treatment pathway to enable safe discharge and patient-initiated follow-up (PIFU) where required. Method All patients with metatarsal fractures between March and May 2021 had their radiographs, e-records and clinic letters retrospectively reviewed with a one-year follow up. Patients with neuropathy, open fractures and polytrauma patients were excluded. The remaining patients with simple, isolated fifth metatarsal fractures were evaluated. Results 75 patients with an isolated fifth metatarsal fracture were reviewed across three months, with 165 appointments dedicated to them (in person and via telephone). 72% were treated with a metatarsal shoe and 17.3% with a walker boot. One patient required surgery for non-union. £12,018 was spent by the trust for the above appointments, either in person (£152 per unit) or via telephone (£20 per unit). Conclusions Simple, isolated fifth metatarsal fractures should be discharged directly from A&E in a metatarsal shoe with an information leaflet and PIFU. Neuropaths, open fractures or polytraumas should follow a referral protocol which has been designed for our department based on our findings.