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5th metatarsal fracture child12/21/2023 Of those treated with a cast, 188 were made weight-bearing as tolerated (WBAT), 57 were made non-weight-bearing (NWB), 35 were transitioned from NWB to WBAT after 1–4 weeks, ten were partial weight-bearing (PWB), and three were transitioned from PWB to WBAT. There was no significant difference found between the metatarsal fractured and choice of immobilization. The non-surgical group consisted of 293 children treated in a cast for a mean of 4.3 weeks, 25 treated in a post-op/hard-soled shoe or CAM walker for a mean 3.4 weeks, and nine others who were treated with activity restriction or a splint. Six months without union was defined as a non-union. Delayed union was defined as any fracture not achieving union in the first 3 months, but before 6 months. Final follow-up X-rays were used to assess fracture union, defined by complete resolution of the fracture line and three out of four intact cortices on orthogonal views. A qualitative analysis of fracture displacement and comminution was also noted during radiographic review. Measurements including angulation, translation, and distraction of the bone fragments were performed and recorded, along with the location of the fracture. Pre- and post-treatment radiographic data were reviewed. These groups included an infant and toddler group aged 0–5 years, child group aged 6–10 years, pre-teen and early adolescent group aged 11–15 years, and an older group of those aged 16 years and greater.Įach child’s age, gender, side affected, mechanism of injury, associated injuries, metatarsal involvement, treatment, length of treatment, and return to activities were recorded. The overall cohort was then divided into age-based groups for data collection. Exclusion criteria included those children found to have an open fracture, Lisfranc fracture, or insufficient clinical or radiographic data. The inclusion criterion was based on the ICD-9 code, 825.25. The presence of post-treatment pain did not correlate with the mechanism of injury or the amount of displacement.Īfter Institutional Review Board approval was obtained, a retrospective chart and radiographic review was performed for all consecutive children treated for a metatarsal fracture during a 2-year period from 2006 to 2007. Only 14 children complained of residual post-treatment pain and all of those cases had been treated without surgery. Return to sports took longer in the operative group, with a mean of 4.0 compared to 2.1 months ( p < 0.001). Complete union was achieved in 84.6 %, with no difference in treatment groups regarding the time of release to full activities, and of the 50 delayed unions, only two required subsequent operative interventions. Logistic regression demonstrated that, for every year of age, the likelihood for surgery increased by 32 % and that children were 6.6 times more likely to have surgery if they had multiple metatarsal fractures. The amount of fragment translation significantly correlated with a decision for surgery ( p = 0.001), but not angulation. Evidence of multiple metatarsal fractures was seen in only 28 % of the non-surgical group compared to 70 % of the surgical group ( p = 0.009). None of the patients under the age of 12 years underwent surgical intervention ( p = 0.005). Only age, multiplicity of metatarsal fracture, and fracture translation was statistically different between the non-surgical and surgical cohorts. We identified 337 children that met the criteria.
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