Iatrogenic fracture gapping during fixation of Jones fractures: Anatomic and mechanical considerations in a cadaveric model

Kaiser, Philip; Riedel, Matthew D.; Qudsi, Rameez A.; Ghorbanhoseini, Mohammad; Kwon, John Y.

doi:10.1016/j.injury.2018.04.024

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…8,15 Larger screws, however, have increased insertion torque and may rotate the proximal fracture fragment. 11 The current study finds that if larger screws cause rotation of the proximal fragment, this may lead to a malunion of the joint surface. The clinical implications of this are an area of future proposed research.…”

Section: Discussionmentioning

confidence: 62%

Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

Qatu

Borrelli

Traynor

et al. 2021

Foot & Ankle Orthopaedics

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Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

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Section: Discussionmentioning

confidence: 62%

Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

Qatu

Borrelli

Traynor

et al. 2021

Foot & Ankle Orthopaedics

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“…However, the surgical method employed in their study was modified tension band wiring. In a cadaveric study, Kaiser et al 12 found that iatrogenic fracture gapping occurs during intramedullary screw fixation for Jones fractures and suggested the need for maintaining fracture reduction in intramedullary screw fixation. However, there have been no reports investigating the effect of the plantar gap widening on the clinical results of intramedullary screw fixation.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes

et al. 2021

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Background: Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still being investigated. Purpose: To review experiences with intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures in high-level athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively analyzed 37 high-level athletes (Tegner activity score ≥7) who underwent intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures between August 2005 and August 2017. The minimum follow-up period of the patients was 2 years. In assessing the surgical results, time to obtain bone union, time to return to original level of sport participation, and treatment failures/complications were reviewed. Additionally, the effect of intraoperative plantar gap widening caused by the screw insertion was analyzed. The surgical results of the 2 groups, the no-gap group (intraoperative plantar gap widening, <1 mm) and the gap group (intraoperative plantar gap widening, ≥1 mm), were compared, while correlations between intraoperative plantar gap widening and the surgical results were statistically analyzed. Results: Bone union and return to the original sport were attained in all patients without treatment failures/complications such as delayed union, nonunion, or refracture. The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group (n = 16) and the gap group (n = 21), no significant differences in the time to obtain bone union ( P = .392) or to return to sport ( P = .399) were noted. Additionally, there was no correlation between intraoperative plantar gap widening and the time to obtain bone union ( r = 0.131; P = .428) or to return to sport ( r = 0.160; P = .331). Conclusion: The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique.

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“…In addition, Lam et al showed that headless compression screws achieved a significantly higher amount of stiffness than conventional, partially threaded screws, although there was no significant difference with regard to compression. 30…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Although intramedullary screw fixation of Jones fractures is a technically straightforward procedure with mostly excellent results, complications including cuboid irritation, nonunion, and refracture can occur. 30 Plantarlateral plate fixation of fifth metatarsal fractures is a reasonable alternative to axial screw fixation and has demonstrated increase load to failure and decreased fracture gapping. 25 In addition, this technique further allows for primary bone grafting of the fracture site.…”

Section: Figurementioning

confidence: 99%

Fifth Metatarsal Jones Fractures: Diagnosis and Treatment

Metzl

Bowers

Anderson

2021

J Am Acad Orthop Surg

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A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent surgical technique and postoperative management, a delayed union and refracture can occur. These complications in athletes can have deleterious effects on performance and delay return to sport. This article reviews the classification, diagnosis, and treatment considerations for Jones fractures. Treatment options including nonsurgical management, intramedullary screw, and plate fixation will be covered. The authors preferred technique using intramedullary screw fixation will be discussed in depth. Emerging considerations including biologic augmentation, primary bone grafting, and refracture will be examined as well. Ideal rehabilitation protocols, orthoses, and shoe wear suggestions will be given to optimize patient outcomes.

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Iatrogenic fracture gapping during fixation of Jones fractures: Anatomic and mechanical considerations in a cadaveric model

Cited by 5 publications

References 13 publications

Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes

Fifth Metatarsal Jones Fractures: Diagnosis and Treatment

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