Acute Fifth Metatarsal Tuberosity Fractures: A Systematic Review of <scp>Nonoperative</scp> Treatment
Bibliographic record
Abstract
OBJECTIVE: Acute metatarsal fractures are a common lower extremity injury. Although surgery may be recommended in specific cases, most are treated nonoperatively. Treatment protocols vary significantly among practitioners, with no consensus on the most efficacious approach. This systematic review aims to identify the effect of treatment protocols on union rate and functional outcome after an acute fifth metatarsal tuberosity fracture. LITERATURE SURVEY: Multiple databases, including CINAHL, EMBASE, MEDLINE, and the Cochrane CEntral Register of Controlled Trials (CENTRAL) were searched from database inception to March 4, 2018 to identify clinical studies addressing nonoperative management of metatarsal fractures reporting nonunion, pain, and/or length of recovery. METHODOLOGY: Two reviewers independently completed title, abstract, and full-text screening. Data abstraction was completed in duplicate. Outcome measures and complications were descriptively analyzed. SYNTHESIS: A total of 1941 studies were eligible for screening. Seven studies (four randomized controlled trials and three prospective cohort studies) satisfied inclusion criteria. This resulted in a total of 388 patient with acute fifth metatarsal tuberosity fractures in 12 different treatment arms, with the most common treatment including plaster casting (7). The mean age was 42 years (27 to 56 years), and the overall nonunion rate was low (1.1%). Four unique functional scores were reported across all studies, and all showed good to excellent short-term results. The overall qualities of studies were moderate, with particular limitations in randomization and concealment allocation. CONCLUSION: Most acute fifth metatarsal tuberosity fractures heal well, with good-to-excellent functional outcomes with nonoperative treatment, regardless of technique. We recommend a conservative rehabilitation framework, including 2 to 3 weeks of immobilization in a walking cast, followed by gradual increase in activity and strengthening until clinical union is achieved.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".