BACKGROUND
Patient-related predictors of pain and functional recovery after conservative fifth metatarsal fracture management remain unclear.
PURPOSE
To evaluate clinical outcomes and identify factors associated with pain reduction.
STUDY DESIGN
Retrospective Cohort Study.
METHODS
Ninety-nine patients with conservatively managed fractures were evaluated (minimum 12-month follow-up). The primary outcome was pain reduction (ΔNRS%), with absolute NRS change reported alongside. Secondary outcomes included time to union (bridging callus), return to daily activities, clinical recovery, and functional scores (FAAM, AOFAS). Multivariable regression evaluated independent associations.
RESULTS
The cohort (41 women, 58 men; mean age 43.2 years, BMI 26.5 kg/m²) predominantly sustained zone 1 fractures. All achieved early radiographic healing (bridging callus; mean 4.0 weeks), and complete union without complications. Mean NRS decreased from 6.79 to 0.68 (mean absolute reduction, 6.11 ± 0.79 points). Mean FAAM and AOFAS scores were 98.37 and 97.68. Most returned to daily activities within 5 weeks (n=65) and recovered within 8 weeks (n=74). Within this cohort, BMI was the only variable independently associated with ΔNRS%, with higher BMI associated with less pain improvement.
CONCLUSION
Conservative management yielded favorable outcomes in this predominantly zone 1, minimally displaced cohort (mean initial displacement 0.53 ± 0.79 mm; median 0 mm). BMI was the only variable independently associated with the magnitude of pain recovery; however, because metabolic, nutritional, occupational, and adherence-related variables were unavailable, BMI is best regarded as a pragmatic clinical marker of slower symptomatic recovery rather than a demonstrated causal determinant. Zone-specific findings require caution given limited zone 3 cases.
LEVEL OF EVIDENCE
Level IV, Therapeutic.
Ahmet Taha Yakıt, Avni Tan, Sefa Parlak et al.· Journal of Foot and Ankle Su...· 0 citations
Aim: To examine whether computed tomography (CT)-derived cross-sectional area (CSA) and radiodensity (Hounsfield units, HU) of the psoas, gluteus maximus, and gluteus medius-minimus are associated with postoperative function in women aged ≥65 years treated with a proximal femoral nail (PFN) for intertrochanteric fracture.Materials and Methods: Sixty-three women aged ≥65 years undergoing PFN fixation for intertrochanteric fracture were analyzed retrospectively. Muscle measurements were obtained on standardized axial CT slices by manual tracing. Function was assessed with the Functional Ambulation Classification (FAC), Parker Mobility Score, Barthel Index, and modified Harris Hip Score (mHHS). Analyses included Spearman correlations with Benjamini-Hochberg false discovery rate (FDR) correction (24 comparisons in a predefined plan), HC3 robust linear regression adjusted for age and ASA, and area under the receiver-operating-characteristic curve (AUC) at clinically meaningful thresholds.Results: The median age was 74 years (IQR 67.5-82.0); median follow-up nine months. Gluteus maximus CSA correlated with Barthel (rho=0.34, p=0.007) and FAC (rho=0.30, p=0.015); an exploratory gluteal CSA composite showed a slightly stronger correlation with Barthel (rho=0.35, p=0.005). Gluteus maximus CSA discriminated community ambulators (FAC≥4) with AUC=0.71 (95% CI 0.55-0.85), and gluteus medius-minimus CSA discriminated Barthel≥90 with AUC=0.73 (0.60-0.85). No association survived FDR correction. Added to age, ASA, and pre-fracture ambulation, the gluteal CSA composite contributed only 0.5-2.2% incremental R².Conclusions: CT-derived gluteal muscle quantity showed the most consistent nominal association with function after PFN, but no association survived FDR correction and incremental value beyond routine clinical predictors was limited. The proposed cut-offs are hypothesis-generating and require prospective validation.
Fatih Erdem, Mustafa Çeltik· Ege Tıp Dergisi· 0 citations
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