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The technological developments within the National Health Service (NHS) provide a foundation to improve the quality of care and patient satisfaction without additional costs. This is attained by replacing the traditional clinic pathway for a virtual platform, where the consultations can occur with fewer resources and physicians. This audit has reviewed the efficiency of the Virtual Fracture Clinic (VFC) in University Hospital of South Manchester NHS foundation trust (UHSM) in managing fractures of the proximal fifth metatarsal. A significant difference is visible in the management of this type of fracture in particular if it is doubted to be a Jones’ fracture, as the boundaries for this are ambiguous. Sir Jones’ was the first to describe this type of fracture as a break at the “proximal 3⁄4 segment of the shaft distal to the styloid” [1], now this is discussed as a fracture at the junction of the metaphysis and diaphysis without distal extension. It is significant to identify this type of fracture as it occurs in an area of rich blood supply thus an increased likelihood of leading to delayed union, non-union and difficulties in treatment [2]. A large proportion of such location are tuberosity related and have an excellent outlook as it is not concerning in relation to the anatomy (Zone 1, Dameron-LawrenceBofte Classification [3]) compared to those at metaphysis-diaphysis junction (Zone 2, Dameron-Lawrence-Bofte Classification [3]) or stress fractures at the diaphysis including the proximal 1.5 cm (Zone 3, Dameron-Lawrence-Bofte Classification [3]). (Figure 1). There are different ways to classify fractures including anatomically: base, shaft, neck and head (Figure 2) [4]; however, this does not guide towards a prognosis unlike the Torg Classification. The recommendations Torg et al’s study makes for the management of these fracture is dependent on the fracture’s radiological appearance and healing potential. Type 1 are described as a thin fracture line with no evidence of intramedullary sclerosis, type 2 is characterised by a wider break line with clear evidence of sclerosis and the complete filling of the medullary canal by sclerotic bone classes as type 3. Based upon the morphology and position of the fracture it is classified in the Stewart classification system (Figure 3) [5].

How are fifth metatarsal fractures managed by the virtual fracture clinic?