Overwhelming demand for trauma services driven by increasing emergency department attendances, has increased pressure on fracture clinics in many units. The British Orthopaedic Association (BOA) guidelines on Fracture Clinic Services, states that all patients should be seen in a new fracture clinic within 72 hours of injury presentation [1]. With increasing numbers of referrals and decreased capacity, this is becoming increasingly difficult to achieve [2]. The widespread use of Virtual Fracture Clinics (VFCs) has provided a safe, effective solution to these challenges. The implementation of these pathways has been expedited by the requirements for physical distancing measures introduced during the COVID -19 pandemic [3]. Benefits of the VFC model include time efficiency, cost-effectiveness and accessibility [4]. That said, critics of the model highlight increased potential for delayed or missed injuries, inadequate treatment and poorer protection against medicolegal claims [5]. There is currently a lack of evidence to support the use of a VFC model in the management of fifth metatarsal fractures.

Metatarsal fractures are the most common fractures in the foot, with fifth metatarsal fractures representing up to 45% of these injuries [6]. Despite the high incidence of fifth metatarsal base fractures, there remains little consensus regarding their optimum treatment. Treatment options include protected weight bearing, immobilisation or surgery depending on location of the fracture, degree of displacement, and functional requirements of the patient. These injuries are predisposed to poor healing due to the limited blood supply of specific areas at the fifth metatarsal base [7]. Injury complications may include pain, delayed union, painful mal-union and non-union. When classified according to the Lawrence and Botte classification, nondisplaced, conservatively managed zone 1 fractures have low non-union rates reported between 0.5% and 1%, whereas zone 2 injuries have reported non unions rates as high as 15 to 30% [8,9].

The safety and efficacy of VFC management of fifth metatarsal base fractures has been assessed before, with limited assessment of patient reported outcomes (PROMS) or satisfaction with the VFC pathway [10]. The primary aim of this study aim is to assess short term clinical and patient reported outcomes following managing fifth metatarsal fractures within a VFC model. Secondary aims include assessing associated patient satisfaction levels and an estimate of cost saving. We hypothesise that the VFC model can be both safe and acceptable to patients using the service.