An illustration to represent zone 1, 2 and 3 of the Dameron-Lawrence-Bofte classification įigure 2. Based upon the morphology and position of the fracture it is classified in the Stewart classification system (Figure 3). Type 1 are described as a thin fracture line with no evidence of intramedullary sclerosis, type 2 is characterised by a wider break line with clear evidence of sclerosis and the complete filling of the medullary canal by sclerotic bone classes as type 3. The recommendations Torg et al’s study makes for the management of these fracture is dependent on the fracture’s radiological appearance and healing potential. There are different ways to classify fractures including anatomically: base, shaft, neck and head (Figure 2) however, this does not guide towards a prognosis unlike the Torg Classification. A large proportion of such location are tuberosity related and have an excellent outlook as it is not concerning in relation to the anatomy (Zone 1, Dameron-Lawrence-Bofte Classification ) compared to those at metaphysis-diaphysis junction (Zone 2, Dameron-Lawrence-Bofte Classification ) or stress fractures at the diaphysis including the proximal 1.5 cm (Zone 3, Dameron-Lawrence-Bofte Classification ). It is significant to identify this type of fracture as it occurs in an area of rich blood supply thus an increased likelihood of leading to delayed union, non-union and difficulties in treatment. Sir Jones’ was the first to describe this type of fracture as a break at the “proximal ¾ segment of the shaft distal to the styloid”, now this is discussed as a fracture at the junction of the metaphysis and diaphysis without distal extension. A significant difference is visible in the management of this type of fracture in particular if it is doubted to be a Jones’ fracture, as the boundaries for this are ambiguous. This audit has reviewed the efficiency of the Virtual Fracture Clinic (VFC) in University Hospital of South Manchester NHS foundation trust (UHSM) in managing fractures of the proximal fifth metatarsal. This is attained by replacing the traditional clinic pathway for a virtual platform, where the consultations can occur with fewer resources and physicians. The technological developments within the National Health Service (NHS) provide a foundation to improve the quality of care and patient satisfaction without additional costs. UHSM: University Hospital of South Manchester NHS foundation Trust VFC: Virtual Fracture Clinic NHS: National Health Service A&E: Accident and Emergency CT: Computed tomography MRI: Magnetic Resonance Imaging. However, Zone 2 fractures are more likely to need a surgical approach and thus should receive a follow up appointment at 6 weeks. In this cohort, 4 patients required operative management, 3 of these were Zone 2 and 1 was Zone 1.Ĭonclusion: Zone 1 and 3 fractures require conservative management and could be discharged routinely with advice that it could take up to 12 weeks to heal. The highest occurrence of non-union is in Zone 2 of 57%, 29% in Zone 1 and 14% in Zone 3. It is shown that there is a 57% chance of delayed union in Zone 1 and 43% likelihood in Zone 2, where the treatment period is longer than 12 weeks. Using the Dameron-Lawrence-Bofte classification it was found that 73.6% were Zone 1, 22.2% were Zone 2 and 4.2% were Zone 3. Results: Out of the 270 patients that presented to the Virtual Fracture Clinic with fifth metatarsal fractures, 53.3% were basal fractures of the fifth metatarsal. Their data was then identified for treatment, non-union and delayed union. Materials and methods: Study of 270 patients conducted over a period of 19 months classified the fractures using Dameron-Lawrence-Bofte classification, the Torg classification and the Stewart classification. Background: A fifth metatarsal fracture is a frequent type of fracture that is not classified during assessment.Īims: To analyse the patterns in management plans of patients that have presented with basal fifth metatarsal fractures to promote a change in the service provided.
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