P002: Do 5th metatarsal fractures need to be managed by orthopaedic surgeons?

Abstract

Introduction: There is increasing evidence that emergency room physicians or primary care physicians can definitively manage many uncomplicated paediatric fractures without orthopaedic follow-up. This strategy leads to a reduction in radiation exposure and decreased costs to patient families and the healthcare system without impacting patient outcomes. The aim of this study was to determine whether patients who sustained an isolated 5th metatarsal fractures require orthopaedic surgeon follow-up. Methods: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of metatarsal fractures from 2009-2014 was performed. Results: 124 patients (66 males, 58 females) with mean age of 11.3 (SD=2.9) years old were included in the study. Complications were minimal with no patients requiring operative management. There were zero non-unions and 3 delayed unions. Despite zero instances of surgical correction and a low complication rate, fracture clinic resource utilization was substantial. Fractures were managed with a mean number of 3.1 (SD=0.98) clinic visits, including initial evaluation in the emergency department. A mean number of 2.8 (SD=1.1) radiology department visits were conducted, with a mean of 8.1 (SD=3.8) x-rays total per patient. Conclusion: Our series supports reduced clinical follow-up of patients with isolated 5th metatarsal fractures. If the diagnosis can be made on the initial radiographs, ER physicians or primary care providers can definitively manage these patients with appropriate immobilization. A fracture clinic follow-up is only necessary if the diagnosis cannot be made on the initial radiographs. Our clinical care pathway will reduce radiation exposure and reduce costs incurred by the healthcare system and patients’ families without jeopardizing patient outcomes.