title: Clinical inquiries. What is the most effective management of acute fractures of the base of the fifth metatarsal?
abstract: For acute Jones' fractures in recreationally active patients, early intramedullary screw fixation results in lower failure rates and shorter times to both clinical union and return to sports than non-weightbearing short leg casting (strength of recommendation [SOR]: A, based on 2 randomized controlled trials [RCT]). Non-weightbearing short leg casting achieves union in 56% to 100% of patients but can require prolonged casting (SOR: B, based on 2 prospective cohorts and multiple retrospective, follow-up studies). Stress fractures were not included in this review. For avulsion fractures of the fifth metatarsal tuberosity, a soft Jones' dressing allows earlier return to pre-injury levels of activity than rigid short leg casting (SOR: B, based on a lower-quality RCT).
authors.affiliation: Moses Cone Family Medicine Residency Program, Greensboro, NC, USA.
authors.forename: Davis
authors.initials: D
authors.lastname: Vu
authors.forename: Todd
authors.initials: T
authors.lastname: McDiarmid
authors.forename: Marcy
authors.initials: M
authors.lastname: Brown
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Aukerman
mesh_terms: D000208:Acute Disease; D001863:Bone Screws; D002370:Casts, Surgical; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000293:injuries* / Q000502:physiology / Q000601:surgery*; D016474:Weight-Bearing