[Conservative therapy for metatarsal 5 basis fractures - retrospective and prospective analysis]. / Konservatives Therapiekonzept bei Metatarsale-V-Basisfrakturen - Retrospektive und prospektive Analyse.

BACKGROUND: Approximately 30 % of all bone injuries are foot metatarsal fractures. Metatarsal V basis fractures occur most frequently. The classification is done into the tuberosity avulsion fractures, Jones fractures and stress fractures of the proximal diaphysis. The treatments of non-displaced fractures are generally conservative. The indication for surgical treatment depends on the load and the associated refracture rate. There are different types of treatment of these fractures. We present a possible approach to conservative treatments and show how different therapies affect healing of metatarsal V basis fractures and social reintegration of patients. METHODS: A retrospective study consisted of 68 patients analysed during a 9-year period, whereas for a prospective analysis 18 patients were included for a period of 3 years. The treatment was performed using either a splint, closed bandage of the ankle or special Göttinger Anklesplint bandage, with immediate pain-oriented full load in all groups. The subjective and objective treatment results were analysed accoding the Göttinger Phillips score. RESULTS: In retrospect, the fracture consolidation was observed after 8.1 weeks full load-bearing was achieved after 6.3 weeks on average. In the prospective analysis, the osseous consolidation occurred after 6.2 weeks, and the full load was applied after 1.7 weeks. After 10 weeks the treatment with the Anklesplint bandage was assessed with 105 points of a maximum 110 points of the Phillips score. The Anklesplint bandage was also the cheapest option in the cost comparison. CONCLUSION: Using the immobilisation of the metatarsal supination with the Anklesplint bandage the metatarsal V basis fractures can heal in a regular way. The functional outcome is better in comparison to the that with other treatments and it is a cost-effective treatment.

[Primary definitive cast therapy on the upper and lower extremities. Indications and cost analysis]. / Primäre definitive Stützverbandbehandlung mit Softcast an der oberen und unteren Extremität. Anwendung und Kostenanalyse.

BACKGROUND: Soft cast (SC) is a semirigid cast material which opened new possibilities for fracture care in adults and children. The primary definitive cast technique (PDCT) with SC is a new casting method that uses a combination of fiberglass and polyurethane resin. Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. METHODS: Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. RESULTS: Compared with PDCT, the costs for POPHC were always higher: 138% for upper arm casts, 142% for lower arm and scaphoid casts, 219% for ankle joint casts, 157% for ankle splints, 336% for first-toe bandage/orthesis, and 289% for geisha shoes. CONCLUSION: The procedure using PDCT with SC can contribute to cost savings and improve patient comfort.