Department of Trauma & Orthopaedics, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
Outcomes Department, Musgrave Park Hospital, Belfast, BT9 7JB, UK.
Eur J Orthop Surg Traumatol. 2024 May;34(4):2171-2177. doi: 10.1007/s00590-024-03921-x. Epub 2024 Apr 3.
Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up.
194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service.
Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery.
The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.
在国民保健制度中，通过虚拟骨折诊所（VFC）直接出院治疗第 5 跖骨骨折已成为常见做法。我们旨在评估一系列第 5 跖骨基底骨折在 1 年随访期间的功能结果和非愈合率。
共纳入 194 例 2019 年 2 月至 2020 年 4 月期间因 VFC 途径就诊的患者。对 X 线片进行评估，以确定骨折在哪个区域，并在后续随访中观察愈合情况。通过电话随访评估患者的功能结果（EQ-5D 和 FAAM 调查）和对 VFC 服务的满意度。
194 例患者中，53 例（27.3%）为 1 区骨折，99 例（51%）为 2 区骨折，42 例（21.6%）为 3 区骨折。80 例患者直接从 VFC 出院，114 例患者至少接受了 1 次面对面的临床随访。6 例（3.1%）患者出现临床和影像学证据的不愈合，其中 4 例为 2 区骨折，2 例为 3 区骨折。未发现 1 区骨折为不愈合。仅 2 例患者接受了手术，其中 1 例为症状性不愈合。在 6 例不愈合患者中，1 例接受了手术，4 例患者不愿手术，最后 1 例不愈合患者被认为不适合手术。
VFC 是管理第 5 跖骨骨折的有效方法，患者满意度高。保守治疗的效果很好，只有少数 2 区和 3 区骨折出现症状性不愈合。功能结果调查提供了进一步的保证。
