Comparative Outcomes of Cast and Removable Support in Fracture Fifth Metatarsal Bone: Systematic Review and Meta-Analysis.

Fractures of the metatarsals account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth metatarsal bone (pseudo-Jones) is protected weightbearing. The methods of protected weightbearing include a short-leg cast and splint (boot cast, Jones bandage, and elastic bandage). However, no consensus has yet been reached regarding which method is most suitable. We conducted a systematic review and meta-analysis to compare the outcomes of a short-leg cast and splint for pseudo-Jones metatarsal fractures. We searched the PubMed and Scopus databases up to October 29, 2016. Five of 104 studies (3 comparative studies and 2 randomized controlled trials; n = 246 patients) were eligible. Of the studies, 3, 5, and 4 were included in pooling of early (within 1 month) and last follow-up foot function scale scores and fracture nonunion, respectively. The unstandardized mean difference of early (within 1 month) and last follow-up foot scores for the short leg cast were -14.58 (95% confidence interval [CI] -24.12 to -5.04) and -3.89 (95% CI -6.30 to -1.49), significantly lower than the scores for the splint (bandage or boot support) for pseudo-Jones fracture of the fifth metatarsal bone. The risk of nonunion of the fifth metatarsal bone fracture of the patients who were treated with short leg cast method was insignificantly greater at 1.57 times (95% CI 0.29 to 8.49) that compared with the splint. The treatment of fracture of the pseudo-Jones fifth metatarsal bone with a splint (boot or bandage) resulted in foot function scale scores better than those with short leg cast treatment and a lower nonunion rate.