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Herterich, Viktoria; Baumbach, Sebastian Felix; Kaiser, Antonia; Boecker, Wolfgang and Polzer, Hans (2021): Fifth Metatarsal Frac ture. In: Deutsches Ärzteblatt International, Vol. 118, No. 35-36: 587-

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Methods: The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones;zone II, in the area of the joint;zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture. Results: Nine studies compared different treatments of zone I fractures. Two of these were randomized controlled trials (RCTs);in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. 28 days;p = 0.001), with otherwise similar outcomes. The non-randomized studies revealed a faster return to full function (33 vs. 46 days;p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters. Conclusion: Fractures in zones I and II should be treated with early functional therapy. There seems to be no reason to consider zone I and II fractures as two

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