title: Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal: a prospective, randomised, single-blinded non-inferiority controlled trial.
abstract: OBJECTIVE
  The purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast. Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior.
  
  
  METHODS
  A total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed.
  
  
  RESULTS
  At four weeks and six months, symptomatic treatment proved non-inferior in terms of primary outcome.
  
  
  CONCLUSIONS
  Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. Significant loss to follow-up with this injury could be expected in longer term. Cite this article: Bone Joint J 2016;98-B:806-11.
authors.affiliation: Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: P I
authors.initials: PI
authors.lastname: Akimau
authors.affiliation: Sheffield Teaching Hospital NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Cawthron
authors.affiliation: Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: W M
authors.initials: WM
authors.lastname: Dakin
authors.affiliation: Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: C
authors.initials: C
authors.lastname: Chadwick
authors.affiliation: Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Blundell
authors.affiliation: Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: M B
authors.initials: MB
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D058128:Compression Bandages; D005260:Female; D000071562:Fractures, Avulsion / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D059012:Lost to Follow-Up; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D064232:Visual Analog Scale; D055815:Young Adult
keywords: Base; Fifth metatarsal; Fracture