Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs

Jimmy J Chan; Amin Mohamadi; Philip Kaiser; Kristen Stupay; Christopher DiGiovanni; Jonathan R Kaplan; Rebecca Cerrato; Clifford Jeng; Ettore Vulcano

doi:10.1016/j.fas.2019.05.015

Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs

Foot Ankle Surg. 2020 Jun;26(4):464-468. doi: 10.1016/j.fas.2019.05.015. Epub 2019 May 30.

Authors

Jimmy J Chan¹, Amin Mohamadi², Philip Kaiser³, Kristen Stupay³, Christopher DiGiovanni³, Jonathan R Kaplan⁴, Rebecca Cerrato⁵, Clifford Jeng⁵, Ettore Vulcano⁶

Affiliations

¹ Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
² Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
³ Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston, MA, United States.
⁴ Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston, MA, United States; Orthopaedic Specialty Insitute, Orange, CA, United States; The Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, United States.
⁵ The Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, United States.
⁶ Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: ettore.vulcano@mountsinai.org.

PMID: 31196695
DOI: 10.1016/j.fas.2019.05.015

Abstract

Background: Management of proximal 5th metatarsal fractures remains a controversial topic in orthopaedic surgery. Both operative and non-operative approaches have been described in the clinical setting. This confusion has led to non-standardized treatment recommendations for proximal 5th metatarsal fractures. This study was designed to analyze concordance rate of treatment recommendations between orthopaedic trainees and orthopaedic foot and ankle experts.

Methods: An online survey containing 14 cases of proximal 5th metatarsal fractures were distributed to 92 orthopaedic residents in two ACGME-accredited programs. Relevant weight-bearing radiographs, patient's age and gender were provided, and two questions regarding treatment recommendations were surveyed. Resident's recommended treatment was then matched against ultimate treatment by orthopaedic foot and ankle experts. ANOVA and T-test are used for associations between the rate of concordant treatment with PGY and trainee foot and ankle experience. Fleiss' kappa was used to assess the inter-observer agreement.

Results: Seventy-two residents returned the survey. The overall concordance rate was 43.98% with no correlation between agreement rate and PGY-years. No difference in agreement rate was observed between residents who had completed their foot and ankle rotation versus those who had not. There was a slight inter-observer agreement in recommending treatment among all residents (κ=0.117, 95% CI: 0.071-0.184).

Conclusions: Our data demonstrated no significant concordance between resident level in training regarding proximal 5th metatarsal fracture treatment decisions, nor between residents and subspecialty-trained foot and ankle surgeons. Increased rotations with foot and ankle fellowship-trained surgeons throughout residency may be desirable to improve the quality of residency training.

Level of evidence: III.

Keywords: Fifth metatarsal fracture; Resident education; Trauma.

MeSH terms

Female
Foot Injuries / surgery*
Fractures, Bone / surgery*
Humans
Internship and Residency / methods*
Male
Metatarsal Bones / surgery*
Orthopedic Procedures / education*
Orthopedics / education*
Practice Guidelines as Topic*