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Background: There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures.
Hypothesis: Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment.
Study Design: Randomized controlled clinical trial; Level of evidence, 1.
Methods: Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient.
Results: Mean follow-up was 25.3 months (range, 15–42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with P < 001.
Conclusion: There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.
I have used tension band wiring for Jones fractures for the past 20 years and think that this type of internal fixation make more sense mechanically than screws. Placing the fixation device on the tension side of the fracture seems to me the most mechanically sound method of treating these fractures.
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Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal International Orthopaedics
Quote:
Abstract The purpose of this study was to identify those factors that influence the outcome after conservative treatment of undisplaced fractures of the fifth metatarsal. This was done with univariate analyses and, for the first time, with regression analyses of day-to-day clinical practice. Thirty-eight patients were treated with plaster and periods of no weight bearing (NWB). Their mean age was 48 years. They were evaluated using the Olerud ankle score, with analogue scales for pain and comfort, and with questions about cosmesis and wearing of shoes. Six patients sustained a Jones fracture and 32 a tuberosity avulsion fracture. The mean period of NWB was 17 days and of casting was 38 days. Three Jones fractures and all the avulsion fractures were healed at the end of treatment. After a mean of 490 days, the global ankle score was 82/100. Ten patients reported problems with shoes and nine reported cosmetic problems. The linear analogue scale for pain was 2.11/10 and for comfort 8.42/10. Gender, age, and fracture type did not affect outcome. The most significant predictor of poor functional outcome was longer NWB, which was strongly associated with worse global outcome, discomfort, and reported stiffness. NWB should be kept to a minimum for acute avulsions of the tuberosity of the fifth metatarsal.
Screw Fixation Versus Casting Jones Fractures
Linear Mode
