Case example II—Fifth metatarsal fracture
A 50-year-old woman presents to the Emergency Department (ED) complaining of pain on the lateral side of her foot after missing the last step of the stairs. The patient is examined by an ED physician or Orthopaedic consultant. Radiographic imaging of the foot reveals a non-displaced fracture of the base of the fifth metatarsal bone (i.e., Zone 1/Dancer’s fracture)
Treatment before implementation of direct discharge	Treatment after implementation of direct discharge
A plaster cast/splint is applied in the ED  A follow-up appointment is scheduled in the fracture clinic in 7 days  After 7 days, the cast/splint is removed and a new splint is applied. The patient is scheduled for another appointment in 5 weeks  After 5 weeks, the splint is removed and radiographic imaging is performed. The radiograph shows first signs of bone healing  Based on local protocols and physician preference/examination, the patient is then either;  discharged from further follow-up with instructions regarding sports, etc reviewed again in a few weeks to assess functional outcome and perform radiographic imaging	A removable orthosis (walker boot) is applied in the ED  Verbal instructions are provided in the ED with regard to the injury, recovery, when to remove the walker, when to contact the hospital etc  This is also summarized in a discharge leaflet and/or smartphone application  No follow-up appointments are scheduled  It is allowed to remove the orthosis e.g., to take a shower, patients are instructed to use the walker for 6 weeks and wear a supportive shoe  A special telephone helpline is available in case of any questions or concerns. If necessary, a face-to-face follow-up appointment is scheduled, and/or imaging is performed