916 Introducing a New Guideline for the Fifth Metatarsal Fracture (5th MTF)

Abstract

Background The 5th MTF is a common injury occurring in the long bone joining the ankle to the toes. This injury can be categorised into two main sub-sections, namely green zone fractures (GZF) and red zone fractures (RZF) which are treated differently. Moreover, patients suffering from uncomplicated GZF are to be discharged directly from emergency department (ED), whereas the complex cases require a review from orthopaedic doctors. Due to time-restraint in ED, some fractures might be misdiagnosed/referred directly to fracture clinics unnecessarily. Aim Increase ED-led management and discharge of patients suffering from GZF Method A QI was introduced to implement a new guideline and update the patient information leaflet in the emergency department at ELHT. For each set of baseline data, an intervention was suggested to achieve the goal of this project and ensure a safe discharge of patients from ED. Results During a four-week study period, 20 patients presented to ED with an uncomplicated green zone fracture, 40% of which were discharged directly from ED. This demonstrates an improvement of 12.7% from a baseline of 27.3%. In addition, 80% of these patients were managed with a walker boot, as mentioned in the new guideline. In total, only three fracture clinic appointments were booked, due to complications, as opposed to twenty appointments. This resulted in a saving of £1.835,4. Conclusions The new guideline has led to an improvement of 50% in patient care. The new management plan benefits patients and improves the efficacy of the ED as well as fracture clinics.