Study finds, Adequate union rates for the treatment of acute
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A Study was conducted to compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures.

All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method. 32 articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies.

--627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment.

--Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases.

--For Jones’ (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively.

--Only 10 proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks.

Finally, Acute zone 1 fractures should be handled conservatively because both conservative and surgical treatment resulted in comparable union rates. Acute zone 2 fractures, have a higher incidence of union and a shorter time to union when handled surgically. Since the results of acute zone 3 fractures are widely recorded, treatment guidelines are unknown.