Randomized Controlled Trial for Conservative Versus Operative Management for Fracture Base of Fifth Metatarsal

Abstract Aim: To assess the clinical and radiological outcomes of fractures base of the fifth metatarsal bone after treated with conservative treatment/operative procedure. Materials and Methods: A randomized data from 38 patients with fracture base of the fifth metatarsal treated with either conservatively (below-knee cast) or operatively (CCS) at Tezpur Medical College and Hospital between October 2022 and April 2024 were evaluated. We included patients with displaced fracture base of the fifth metatarsal in the age group 18–60 years who were followed up for at least 6 months and excluded patients with follow-up of less than 6 months, pathological fractures, age less than 18 and more than 60 years, open fractures of the foot, and osteoporotic fractures. Patients were treated with below-knee cast application with eversion of the foot for a period of four weeks in the conservative group. In the operative group, the patient was treated with percutaneous or open CCS fixation. American orthopaedics foot and ankle score (AOFAS) and visual analog score (VAS) scores were used to evaluate the patients of both groups. Both the groups were also compared with radiological time of union and time of full weight bearing. Results: The statistical analysis comprised a total of 38 patients. With a mean age of 40.5 years in the conservative group and 40.6 years in the operative group, there were eight males and 11 females in the conservative group and 11 males and eight females in the operative group. At the end of the follow-up period, the AOFAS in the operative group was 92.2, and in the conservative group, it was 82.4 which was statistically significant. The radiological time of union in the operative group was 7.9, and in the conservative group, it was 11.9 which was significant. Conclusion: From our study, we can conclude that operative management is better than conservative management, as statistically significant differences were noted with “ P ” values less than 0.05 in terms of AOFAS score, VAS score, time taken to full weight bearing, and also for radiological union.