Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture

Glasgow, M.; Naranja, R. John; Glasgow, S. G.

doi:10.1097/00004694-199703000-00065

Cited by 16 publications

(24 citation statements)

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“…Similarly, Glasgow et al found that early return to play was associated with delayed union and refracture in patients treated with a 4.5-mm malleolar screw, indicating that this screw diameter did not provide sufficient support to allow healing. 8 In our experience, some players who are pain-free and able to return to play have a persistent plantar and/or lateral gap with bridging trabeculation dorsally and medially. Breakage of 5.5-and 6.5-mm indication-specific screws has been exceedingly rare in patients treated at our institution because the bending rigidity of this intramedullary implant is proportional to its radius to the 4th power.…”

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confidence: 73%

Return to Play in National Football League Players After Operative Jones Fracture Treatment

2015

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Background: Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. The purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. Operative treatment for the majority of patients involved fixation with a Jones-specific intramedullary screw and iliac crest bone marrow aspirate with demineralized bone matrix injected at the fracture site. Additionally, our protocol involved the use of noninvasive bone stimulators, application of customized orthoses, and an aggressive patient-specific rehabilitation protocol. Patient demographics were recorded along with position played, seasons played after surgery, RTP, and complications. RTP was defined as the ability to play in a single regular-season NFL game after surgery. At the time of surgery, average age for all patients was 24.0 years and BMI 31.0. Results: Player positions included 8 wide receivers, 4 linebackers, 4 tight ends, 2 defensive tackles, 2 cornerbacks, 1 offensive tackle, 1 center, 1 tackle, 1 defensive end, and 1 quarterback. Seventy-six percent of players underwent operative fixation during their first 3 seasons. Forty-eight percent were diagnosed before or during their rookie (first) season. RTP was 100% for all players and 80% were still playing at time of publication. Three patients (12.0%) refractured and required revision surgery. Time until RTP was influenced by other variables and difficult to measure because many surgeries were performed early in the offseason. All 9 players who underwent surgery between July and October, and were therefore eligible to return to play in the same season, had an average RTP of 8.7 weeks (range 5.9-13.6). Conclusion: With an appropriately placed intramedullary screw and an aggressive rehabilitation protocol, early RTP was achievable with a low refracture rate in professional athletes. All NFL players in this series were able to return to play after surgery. We observed that these injuries were more likely to occur in the first 3 seasons of play and in wide receivers, linebackers, and tight ends. This at-risk subset of players may benefit from improved preventative measures. Level of Evidence: Level IV, retrospective case series.

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confidence: 73%

Return to Play in National Football League Players After Operative Jones Fracture Treatment

2015

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“…La ventaja de un tornillo canulado es la gran precisión y la facilidad de la colocación del tornillo sobre una aguja guía 31,36 . Sin embargo, un estudio realizado por Glasgow et al (1996) informó del riesgo de recidiva en la fractura fijada con tornillos canulados 37 . Un estudio reciente realizado por Scott et al (2015) determinó que un tornillo de 4,5 mm es el tornillo de diámetro más pequeño que se puede utilizar eficazmente para la fractura del quinto metatarsiano 38 .…”

Section: Tratamiento Quirúrgicounclassified

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

López

2018

Rev. Int. Cienc. Podol.

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Resumen. La fractura de Jones se define como una fractura transversal localizada en la unión de la diáfisis con la metáfisis proximal en el quinto metatarsiano y es una de las lesiones más comunes que aparecen en el pie. Es una zona pobremente vascularizada, lo que conlleva altas tasas de no unión de la fractura. Se diagnostica con un exploración clínica, asociada a pruebas radiológicas, siendo necesarias tres proyecciones: lateral, antero-posterior y una oblicua de 45º. Hay distintas clasificaciones como son la de Torg et al. y Dameron et al., que nos ayudan a establecer un tratamiento, en función de la localización de la fractura y su evolución radiológica. El objetivo de este trabajo es realizar una revisión en la literatura científica para valorar las diferencias en los resultados entre el tratamiento quirúrgico y tratamiento conservador, en relación al tiempo de unión ósea y las posibles complicaciones, determinando así cual es el tratamiento óptimo para estas fracturas. Se llega a la conclusión de que el tratamiento conservador es una opción viable, pero conlleva mayores tasas de no unión y mayor tiempo de retorno a la actividad física que el tratamiento quirúrgico, aunque este puede llevar a una serie de complicaciones tales como la lesión del nervio sural o una posible fractura iatrogénica del metatarsiano. El tratamiento quirúrgico, que consiste mediante la fijación con un tornillo intramedular, tiene menor tiempo de reincorporación a la actividad habitual y mayores tasas de consolidación ósea por lo que será de primera elección en deportistas. Palabras clave: fractura de jones; tratamiento quirúrgico; tratamiento conservador.[en] Jones Fracture. Surgical treatment or conservative treatment?Abstract. Jones' fracture is defined as a transverse fracture located at the junction of the diaphysis with the proximal metaphysis in the fifth metatarsal and is one of the most common lesions that appear in the foot. It's a poorly vascularized area, which leads to high rates of non-union of the fractures. It is diagnosed with a clinical examination, associated with radiological tests, three projections are necessary: lateral, antero-posterior and an oblique of 45º. There are different classifications such as Torg et al. and Dameron et al., which help us to establish a treatment, depending on the location of the fracture and its radiological evolution. The objective of this study is to perform a review in the scientific literature to evaluate the differences in the results between surgical treatment and conservative treatment, in relation to the time of union and the possible complications, thus determining which is the optimal treatment for these fractures. We conclude that conservative treatment is a viable option, but it leads to higher rates of non-union and greater time to return to physical activity than surgical treatment, although this may lead to a series of complications such as injury Sural nerve or a possible iatrogenic fracture of the metatarsal. The surgical treatment, which consists of the fixation wi...

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“…These methods have high success rates. (5) The use of lag screws provides an additional mechanical advantage, as they are stronger than single screws. (6) Due to the very small fragments associated with proximal fractures, it is rare to have more than one screw placement opportunity.…”

Section: Introductionmentioning

confidence: 99%

Accurate determination of screw position in treating fifth metatarsal base fractures to shorten radiation exposure time

Wang¹,

Zhang²,

Wang³

et al. 2016

smedj

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Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture

Cited by 16 publications

References 0 publications

Return to Play in National Football League Players After Operative Jones Fracture Treatment

Return to Play in National Football League Players After Operative Jones Fracture Treatment

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

Accurate determination of screw position in treating fifth metatarsal base fractures to shorten radiation exposure time

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