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

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.

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  • Authors+Show Affiliations

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    Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

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    Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.

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    Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston, MA, United States.

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    Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston, MA, United States.

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    Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston, MA, United States.

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    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.

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    The Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, United States.

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    The Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, United States.

    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.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31196695

    Citation

    Chan, Jimmy J., et al. "Factors Influencing Treatment Recommendations for Base of 5th Metatarsal Fractures in Orthopaedic Residency Programs." Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, 2019.
    Chan JJ, Mohamadi A, Kaiser P, et al. Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs. Foot Ankle Surg. 2019.
    Chan, J. J., Mohamadi, A., Kaiser, P., Stupay, K., DiGiovanni, C., Kaplan, J. R., ... Vulcano, E. (2019). Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs. Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, doi:10.1016/j.fas.2019.05.015.
    Chan JJ, et al. Factors Influencing Treatment Recommendations for Base of 5th Metatarsal Fractures in Orthopaedic Residency Programs. Foot Ankle Surg. 2019 May 30; PubMed PMID: 31196695.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs. AU - Chan,Jimmy J, AU - Mohamadi,Amin, AU - Kaiser,Philip, AU - Stupay,Kristen, AU - DiGiovanni,Christopher, AU - Kaplan,Jonathan R, AU - Cerrato,Rebecca, AU - Jeng,Clifford, AU - Vulcano,Ettore, Y1 - 2019/05/30/ PY - 2019/01/25/received PY - 2019/05/13/revised PY - 2019/05/23/accepted PY - 2019/6/15/entrez KW - Fifth metatarsal fracture KW - Resident education KW - Trauma JF - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JO - Foot Ankle Surg N2 - 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. SN - 1460-9584 UR - https://www.unboundmedicine.com/medline/citation/31196695/Factors_influencing_treatment_recommendations_for_base_of_5th_metatarsal_fractures_in_orthopaedic_residency_programs L2 - https://linkinghub.elsevier.com/retrieve/pii/S1268-7731(19)30077-3 DB - PRIME DP - Unbound Medicine ER -