Abstract
Fracture to fifth metatarsal’s base is one the most common injury experienced at the foot. 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. 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. To meta-statistically compare the effects of operative and non-operative management of fifth metatarsal base fracture. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. 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. Out of 1,170 records, 11 articles including 404 participants (mean age: 29.8 ± 7.4 years) were included in this review. 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. 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. The current systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal’s base fracture. 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.
Highlights
A combined, across group, random-effect analysis (Fig 10) revealed a large negative significant effect of operative interventions to reduce the perception of pain assessed via visual analog scale after the management of fifth metatarsal base fracture as compared to non-operative conservative management (g: -0.86, 95% C.I: -1.2 to -0.52, p
We report beneficial effects of operative interventions for reducing the rate of non-union, duration of union, duration of return to normal activity, duration of return to sport and visual analog scale score as compared to non-operative interventions
The management of fracture at the base of the fifth metatarsal is a challenging avenue for an orthopedic because of its peculiar vasculature [12]
Summary
The recent systematic reviews too provide inconclusive evidence regarding the optimal choice of treatment [16, 33, 34] Taken together, this lack of consensus has proven to be a challenging avenue for the clinicians to develop an efficient decision-making model for selecting optimal interventions for managing the fifth metatarsal’s base fracture [15]. This lack of consensus has proven to be a challenging avenue for the clinicians to develop an efficient decision-making model for selecting optimal interventions for managing the fifth metatarsal’s base fracture [15] This present study aims to address this gap in the literature by synthesizing the current state of evidence concerning operative and non-operative interventions to manage the fifth metatarsal’s base fracture. This review will provide comprehensive evidence concerning the rate of non-union, duration of union, duration of return to activity, visual analog scale, and the American orthopedic foot & ankle scale score between operative and non-operative interventions
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