Abstract
Introduction
Fifth metatarsal fracture is a common injury. Current practice supports conservative management, with surgery in the event of non-union. Early fracture clinic review is not perceived to improve patient experience or increased detection of non-union. A new protocol standardises treatment to symptom level and discharges patients from ED with advice but without any routine follow-up arranged. A leaflet advises on management, prognosis and helpline details and there is an open-access policy for those whose symptoms persist to investigate potential non-union.
Method
A prospective audit evaluated the protocol, surveying patients at 8-weeks and 6-months post-injury. A minor injuries unit continued to refer to fracture clinic and was the control group. During 6-months 46 acute fractures were recorded in the new protocol(group 1) and 47 in the control(group 2). 1 patient in each group was known to experience non-union. 31 of group 1 and 22 of group 2 responded to at least one survey.
Results
Satisfaction with information provided at initial presentation was high for both protocols. 87%(27/31) satisfied in group 1 and 90%(20/22) group 2(p=1.0000).
At 8-weeks 82%(19/23) were satisfied with their progress following the new protocol compared to 89%(17/19) in the control(p=0.6729). At 6-months 88%(22/25) were satisfied compared to 76%(13/17) respectively(p=0.4133).
The new protocol is not associated with a significant symptoms increase. At 8 weeks 22%(5/23) described their pain severity as >5/10 reducing to 8%(2/25) by 6-months. Compared to 10%(2/19) of the control at 8-weeks and 6%(1/17) at 6-months.
Patients rating fracture management overall as ‘good or excellent’ were comparable between both new, 67%(21/31) and traditional, 77%(17/22) protocols(p=0.5441).
Conclusion
No significant difference in patient satisfaction and symptom levels between the old and new protocol was found. The new protocol reduces unnecessary patient appointments. This reduces demands on fracture clinic while maintaining a safe, resource efficient service.
