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

Mt, Glasgow; Rj, Naranja; Sg, Glasgow; Js, Torg

doi:10.1177/107110079601700803

Cited by 146 publications

(27 citation statements)

References 8 publications

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“…Return to sports should only be allowed when there is radiological evidence of union and the patient is clinically asymptomatic (26). The rehabilitation plan must be accepted by the patient pre-operatively since pre-mature return to vigorous physical activity is believed to cause delayed union and refracture, especially in athletic patients (31). …”

Section: Resultsmentioning

confidence: 99%

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Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Cheung¹,

Lui²

2016

Arch Trauma Res

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ContextFractures of proximal fifth metatarsal are one of the most common fractures of the foot.Evidence AcquisitionA search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.ResultsThe vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.ConclusionsLawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

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Section: Resultsmentioning

confidence: 99%

“…Complications of proximal fifth metatarsal fractures include delay union, non-union and refracture (31). A low non-union rate of 0.5% - 1% was reported in zone 1 fractures treated conservatively (20, 33).…”

Section: Resultsmentioning

confidence: 99%

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Cheung¹,

Lui²

2016

Arch Trauma Res

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“…Although the current gold standard for treatment is intramedullary screw fixation, delayed unions and refractures with this procedure are not uncommon [5,7,8,11,12]. Bone autografiting could solve the problem because it is osteoconductive, osteoinductive, and provides osteogenic cells [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

Tsukada

Ikeda

Seki³

et al. 2012

BMC Sports Sci Med Rehabil

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BackgroundDelayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.MethodsThe authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.ResultsAll patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.ConclusionsThere were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

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“…The theoretical advantage of a cannulated screw is the precision and ease if screw placement over a guidewire[25,37]. However, a study done by Glasgow et al[38] reported the risk of re-fracture with cannulated screws. The study examined operative failure of three delayed unions, three nonunions, and five acute Jones fractures.…”

Section: Operative Treatmentmentioning

confidence: 99%

“…They concluded failure was due to undersized cortico-cancellous grafts and incomplete reaming of the medullary canal. Additionally, early return to vigorous physical activity with the bone graft procedure and screw fixation was associated with re-fractures and delayed union[38]. It should be noted that that in this study the definition of Jones fracture included zone two and zone three fractures.…”

Section: Operative Treatmentmentioning

confidence: 99%

Fifth metatarsal fractures and current treatment

Bowes

Buckley

2016

WJO

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Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literature on management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

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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 146 publications

References 8 publications

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

Fifth metatarsal fractures and current treatment

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