Comparison Different Method Treatment in Tuberosity Fractures of the Proximal Fifth Metatarsal
Comparison Different Method Treatment in Tuberosity Fractures of the Proximal Fifth Metatarsal
Fracture of the base of the fifth metatarsal is one of the most common injuries in ankle
 trauma. There are many conservative treatment protocols for fifth metatarsal base fractures
 which have up to 99% success. Short leg cast and walking boot are conservative treatment
 methods that aim to prevent weight-bearing. There are many different conservative treatment
 methods that allow weight-bearing such as an elastic bandage. There was no significant
 difference between cast and symptomatic treatment in the previous studies. Muscle atrophy
 developing after immobilization with cast may adversely affect the daily activities of the
 patient in the first few months. However, there was no study comparing the effect of these
 two treatment methods on ankle muscle strength.

 In this study, the investigators compared the strength of the ınjured and healthy ankle
 muscle when symptomatic and cast treatment methods are applied to patients with tuberosity
 fractures of proximal fifty metatars. In addition, patients' functional, clinic and
 radiological outcomes were also compared.
We prospectively treated 73 patients with 5th metatarsal base fractures (Zone 1) who came to
 the emergency department. Patients were allocated to a treatment group using an electronic
 random number generator. The generation of an even number randomized the participant to a
 below-knee cast, and an odd number to a double-layered elasticated bandage. In all, patients
 were allocated to wear a double layered elasticated bandage (group 1) applied by S.B and
 patients were given a below-knee cast (group 2) applied by D.K. Duration of both treatments
 were for four weeks and the cast removed in that time in our clinic. This reference form of
 treatment was the same as in previous reports.

 The non-injured extremity was measured with isokinetic test at initial injury time for
 evaluation of side effect of immobilization after treatment. At that time, patients were
 asked for height, weight and pain scores. Body muscle index was calculated for all patients.
 Tobacco using was also asked.To measure clinical outcomes, using the validated Visual
 Analogue Scale Foot and Ankle (VAS-FA) score [7] and The EuroQol-5D visual analogue scale
 (EQ-5D VAS) score were used [8]. The VAS-FA score ranges from 0 to 100 points: higher scores
 indicate a better functional outcome. EQ-5D VAS score was used as a secondary outcome
 measure: this ranges from 0 to 100. Baseline functional scores were collected at the time of
 consult in the clinic.

 Both ankle plantar-dorsiflexors and inversion-eversion'strength (peak torque %BW (Body
 Weight)) were measured with an isokinetic dynamometer (Cybex Humac Norm, CA, USA) at
 Isokinetic Test Laboratory of Sports Medicine in the Istanbul Medical Faculty. Test procedure
 was performed by the same investigator (T.Ş) in all cases for ensuring standardization. The
 muscle strength can be defined as the capacity of a muscle to withstand great force.

 Injured extremity values were compared with non-injured extremity. The non-injured extremity
 was measured at initial injury time for evaluation of side effect of both treatment methods.
 The tests were started with non-injured sides of the patients and measurements at low angular
 velocity. The dynamometer was calibrated at the beginning of each testing session. Subjects
 were tested in prone position and stabilized in the exercise chair as per the manufacturer's
 recommendation. The anatomical axis of the ankle was aligned with the axis of the dynamometer
 while the foot was secured to the foot plate with velcros. Proximal stabilization was
 achieved with the straps at the thigh and calf. In the test, dorsiflexion-plantarflexion and
 inversion-eversion peak torque force (strength) measurements were performed in 3 trials and 3
 tests repetitions at 30 degrees/sec angular speed for both side of the patient.

 All of the patients were given follow-up appointments at 2, 4, 8, 12 and 24 week interval at
 our clinic. Radiographs were similarly scheduled for 4, 8, and 12 week intervals to assess
 bony healing. However, functional outcomes and isokinetic test was applied also at 24 week
 control. At second visit, isokinetic test was not applied. These studies were started on
 fixed ground and then continued on moving boards. Standard rehabilitation program was given
 for all patients each group included joint mobilizations, passive stretching,
 electrotherapy-ice compression for pain relieving and ankle proprioceptive exercises, as
 considered necessary by same author (T.Ş).
Inclusion Criteria:

 -  Aged over 18 years

 -  Acute (presented within one week of injury) Zone 1 fractures of fifth metatarsi

 Exclusion Criteria:

 -  Zone 2-3 fractures

 -  Diabetes mellitus

 -  Osteoporotic bone (T score<-2.5),

 -  History of osteoporotic drug therapy,

 -  Other lower extremity any fracture,

 -  Previous foot surgery or fracture in both lower extremity,

 -  Chronic fracture, pathological fracture,

 -  Aged over 65 years (congruity of muscle strength test)

 -  Open fracture