High union rates of proximal fifth metatarsal stress fractur
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The primary purpose of this study was to determine the union rate and time for surgical- and non-surgical treatment of stress fractures of the proximal fifth metatarsal (MT5). The secondary purpose was to assess the rate of adverse bone healing events (delayed union, non-union, and refractures) as well as the return to sports time and rate.

Methodological quality was assessed by two independent reviewers using the methodological index for non-randomized studies (MINORS) criteria. The primary outcomes were the union time and rate. Secondary outcomes included the delayed union rate, non-union rate, refracture rate, and return to sport time and rate.

A simplified pooling technique was used to analyse the different outcomes (i.e. union rate, time to union, adverse bone healing rates, return to sport rate, and return to sport time) per treatment modality.

Results:
The literature search resulted in 2753 articles, of which 13 studies were included. A total of 393 fractures, with a pooled mean follow-up of 52.5 months, were assessed. Overall, the methodological quality of the included articles was low.

--The pooled bone union rate was 87% and 56% for surgically and non-surgically treated fractures, respectively.

--The pooled radiological union time was 13.1 weeks for surgical treatment and 20.9 weeks for non-surgical treatment.

--Surgical treatment resulted in a delayed union rate of 3%, non-union rate of 4% and refracture rate of 7%.

--Non-surgical treatment resulted in a delayed union rate of 0%, a non-union rate of 33% and a refracture rate of 12%, respectively.

--The return to sport rate (at any level) was 100% for both treatment modalities. Return to pre-injury level of sport time was 14.5 weeks (117 fractures) for surgical treatment and 9.9 weeks (6 fractures) for non-surgical treatment.

In conclusion, surgical treatment of proximal fifth metatarsal stress fractures results in a higher rate of bone union and shorter union duration than non-surgical treatment. In addition, both surgical and non-surgical care showed a high return to the athletic scale (at any level).

Source: https://link.springer.com/article/10.1007/s00167-021-06490-2
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