![]() ![]() 1st 2014 were identified retrospectively using the clinical and radiographic database of the Munich University Hospital. Patients suffering an isolated epi-metaphyseal fracture to the proximal fifth metatarsal bone (L&B type I or II, Fig. The study was conducted by the Division of Foot and Ankle Surgery at the University Hospital of Munich (LMU). The study was approved by the local ethic committee (# 541–14). Retrospective registry study with a prospective follow up. displacement, articular involvement, number of fragments, negatively influence the outcome of functional treatment and therefore require surgery. Furthermore, it remains largely unknown, whether fracture characteristics, i.e. In contrast, strong evidence is available in favour of surgical treatment for L&B type III fractures (meta-diaphyseal fractures). Although these recommendations are based on strong evidence for L&B type I fractures, only little evidence is available for L&B type II fractures. ![]() In summary, L&B type I and II fractures should not be differentiated but be summarized as epi-metaphyseal fractures, as both apparently heal well when treated functionally. Based on this evidence a treatment-oriented adaptation of the L&B classification was concluded. Overall the level of evidence available was moderate. A recent systematic literature review evaluated the validity of the classification system and treatment recommendations by Lawrence and Botte. They differentiated tuberosity avulsion fractures (type I), Jones’ fractures (type II) and diaphyseal stress fractures (type III) (Fig. The most widely accepted classification was published by Lawrence and Botte (L&B) in 1993. Possible causes are missing evidence, various fracture classifications, and diverging definitions for the term “Jones fracture”. Treatment recommendations for fractures to the base of the fifth metatarsal (MTV) are still a matter of debate. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures. (2) Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. (1) Both, L&B I and II fractures featured excellent results with immediate full weightbearing. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments). None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. No complications were reported, no patient required surgery. The VAS-FA score at the final follow-up was 96 ± 4, SF-12 PCS score 57 ± 5 and MCS score 51 ± 8. Patients returned to work after 17 ± 12 days, to sports after 53 ± 22 days. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. L&B type I fractures occurred in 59%, type II in 41%. Thirty-nine patients (40 ± 15 years, 56% female) were enrolled with a mean follow-up of 22 ± 10 months. The influence of the fracture (1) location and (2) -characteristics on these parameters was tested. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. ![]() Fracture location (L&B type I and II) and characteristics (displacement 2 mm, intra-articular involvement, and number of fragments) were assessed. Patients with an acute, isolated, epi-metaphyseal fracture to the fifth metatarsal bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Retrospective registry study with a prospective follow-up. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome. ![]() Of special interest were the influence of (1) the fracture location (L&B type I vs. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. ![]()
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