Early Screw Fixation versus Casting in the Treatment of Acute Jones Fractures

Mologne, Timothy S.; Lundeen, Jeffrey M.; Clapper, Mark F.; O’Brien, Timothy P.

doi:10.1177/0363546504272262

Cited by 189 publications

(218 citation statements)

References 26 publications

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“…24 Multiple studies have also supported the use of early intramedullary screw fixation for this pattern in the active patient population, as results demonstrated a faster return to sport (mean 7.5 weeks) and shorter time to clinical union in competitive athletes. 24,29 Percutaneous fixation with an intramedullary screw is the preferred approach for the treatment of zone 2 fractures as it allows for minimal stripping at the fracture site and can achieve adequate compression ( Figure 5). 10,29 Many authors have assessed what type (cannulated vs noncannulated), size, and length of screw is most appropriate, with screw sizes anywhere from 4.5 mm to 6.5 mm.…”

Section: Treatmentmentioning

confidence: 96%

Metatarsal Fractures

Sarpong

Swindell

Trupia

2018

Foot & Ankle Orthopaedics

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Metatarsal fractures account for a significant proportion of foot injuries, representing 35% of all foot fractures and 5% to 6% of all skeletal injuries, with an estimated incidence of 6.7/10 000 people. 5,28,41,42 These injuries are more common in females (2:1) in the general population, although in the athletic population, they are seen most commonly in males. 28,37,41,42 Patients in their second through fifth decade of life most commonly sustain metatarsal fractures, with a mean age of 42.28 Most metatarsal fractures occur by low-energy trauma, although they can also occur from penetrating trauma.28 Anatomically, the metatarsals fall into 3 groups: first, fifth, and central metatarsals. In a population study investigating metatarsal fractures, fifth metatarsal fractures occurred most commonly, followed by middle metatarsals and the first metatarsal. 28Although most first and fifth metatarsal fractures are isolated fractures, multiple metatarsal fractures often occur in contiguous bones. If a fracture is identified in a single metatarsal, the orthopedist must closely inspect adjacent metatarsals and joints, especially the Lisfranc articulation.28 Stress fractures can also occur in metatarsals, most commonly in the second metatarsal but also not uncommonly in the third and fifth metatarsal. They are seen typically in women with osteoporosis and athletes with repetitive stress injuries, which includes groups as diverse as ballet dancers and military recruits. 36The appropriate and successful management of these fractures requires knowledge of the anatomy, pathophysiology, and treatments for each of the metatarsal fracture groups. Unfortunately, outcomes are generally less predictable in patients with risk factors such as obesity and diabetes.5 This review focuses on acute metatarsal fractures, with only a cursory discussion of stress fractures and Lisfranc injuries. First and Central MetatarsalsFractures involving the first and central (second through fourth) metatarsals can vary significantly, including stress and acute traumatic fractures. First metatarsal fractures are not as common as central metatarsal fractures. 28 There is a 60% rate of contiguous fractures when patients sustain fractures involving the central metatarsals. 28 AnatomyFirst Metatarsal. The first metatarsal is larger than the lesser 4 metatarsals. Distally, there is the transmetatarsal ligament in the first webspace. The resting position of the first tarsometatarsal joint is supported by a capsule containing strong, thick ligaments. The first metatarsal base is the site of attachment for 2 powerful muscles, tibialis anterior and peroneus longus. The first metatarsal head overlies the 2 sesamoid bones, which provides 2 of the 6 contact points of the forefoot and allows the first ray to support up to 40% of the forefoot weight. The blood supply is primarily from a single nutrient artery with secondary epiphyseal and metaphyseal arteries.Central Metatarsals. The central metatarsals have significant ligamentous structures that link each bone to ...

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Section: Treatmentmentioning

confidence: 96%

Metatarsal Fractures

Sarpong

Swindell

Trupia

2018

Foot & Ankle Orthopaedics

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“…La rehabilitación postoperatoria consiste, por lo general, en inmovilización con una férula de yeso durante una o dos semanas y posteriormente, el remplazo por una bota tipo Walker para caminar 20,40,41 . Esta bota reduce significativamente la presión en la base del quinto metatarsiano en la ambulación, en comparación con un zapato postoperatorio 42 .…”

Section: Rehabilitación Postoperatoriaunclassified

“…Esta bota reduce significativamente la presión en la base del quinto metatarsiano en la ambulación, en comparación con un zapato postoperatorio 42 . A las seis/ocho semanas, el paciente podrá apoyar por completo el pie y podrá reanudar su actividad normal 20,40,41 . Los pacientes atletas que se someten a cirugía deberían volver a su actividad deportiva solo si existe evidencia radiológica de la unión de la fractura, y el paciente presenta una clínica asintomática 43 .…”

Section: Rehabilitación Postoperatoriaunclassified

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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“…6 right). © C I C E d i z i o n i I n t e r n a z i o n a l i months (range [12][13][14][15][16][17][18][19][20][21][22][23][24]. The mechanism of injury was ankle inversion sprain and adduction of the foot for most patients (108 pts, 70%) due to indirect trauma during fall from a curb or stairs.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast vs functional bandage

Biz

Zamperetti

Gasparella

et al. 2017

MLTJ

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SummaryBackground: The purpose of this non-randomized retrospective study was to investigate outcomes of minimally displaced, proximal 5MTB fractures, treated by a below-knee walking cast or a functional elasticated bandage with a support of a flat hardsoled shoe. Methods: A consecutive patient series was divided into two groups: the cast group (CG) and the functional group (FG). The subjects were radiologically and clinically evaluated according to Mehlhorn and Lawrence-Botte classification, and AOFAS Midfoot score, respectively. Results: 154 patients were followed up for a median of 15 months (range 12-24). There was no significant difference (p > 0.05) among the outcomes of each fracture pattern regarding the treatment choice.However, an earlier return to sports was noted in the FG, while Type-3 fractures achieved the worst results. Conclusion: Type-1 and 2 minimally displaced 5MTB proximal fractures can be successfully treated conservatively without weight-bearing restriction and without benefit of a cast with respect to a functional elasticated bandage. Level of clinical evidence: level III retrospective comparative study.

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Early Screw Fixation versus Casting in the Treatment of Acute Jones Fractures

Abstract: 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.

Cited by 189 publications

References 26 publications

Metatarsal Fractures

Metatarsal Fractures

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast vs functional bandage

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