![]() ![]() In a rather current review of the literature Polzer et al. The authors distinguish between three types of fractures to the proximal fifth metatarsal bone: type I includes tuberosity avulsion fractures, proximal to the intermetatarsal joint (L&B type I), whereas type II fractures are located at the intermetatarsal joint (L&B type II), and type III fractures are defined as diaphyseal stress fractures, distal to the intermetatarsal joint (L&B type III). The Lawrence and Botte classification is most frequently used nowadays. Over time different classification systems were developed according to the location and number of fragments. The peak incidence of fifth metatarsal fractures in men is below the age of 40, whereas mostly women older than 50 years are affected. More than half of all metatarsal fractures involve the fifth metatarsal bone and the majority is located at the proximal end. Metatarsal fractures are one of the most common injuries of the midfoot with an incidence of up to 75 persons per 100,000 per year among adults. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Overall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. The follow-up time was 58 (min: 15 max: 164) months. Operatively treated L&B type III fractures tended to have a better functional score ( p = 0.16). ![]() Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management ( p = 0.89). L&B type I fractures ( n = 13) had a FAOS score of 91 ± 23, L&B type II ( n = 67) presented a score of 91 ± 15 and L&B type III ( n = 23) a score of 93 ± 11. In total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. For outcome analysis, the nonparametric Mann–Whitney U test was performed and Spearman’s rank correlation coefficient calculated. Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). The fractures were classified according to Lawrence and Botte (L&B). Only patients with a minimum follow-up of 12 months were included. MethodsĪll patients suffering from single fractures to the proximal fifth metatarsal bone between 20 were enrolled in this retrospective analysis. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities. The majority involves the proximal fifth metatarsal bone. Metatarsal fractures are common skeletal injuries of the lower extremity in adults. ![]()
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