Is nonoperative treatment still indicated for Jones fracture?

Chiu, Chee Kidd; Vivek, A S

doi:10.1007/s00068-008-8148-z

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…All pooled results for zone 2 fractures are listed in Table 4. 518 zone 2 fractures were included from 21 studies [1, 3–7, 12, 19, 22, 25, 30, 32, 34, 36, 37, 41, 44, 49–51, 56], of which 318 (61.4%) fractures received conservative treatment and 200 (38.6%) received surgical treatment. The pooled patient characteristics and pooled treatment outcomes of zone 2 fractures are presented in Table 4.…”

Section: Outcome Measuresmentioning

confidence: 99%

Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

Rikken

Dahmen

Hagemeijer

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures. Methods A literature search was performed to identify studies published from the earliest record to January 2019 using EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method. Results Thirty-two articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies. 627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment. Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases. For Jones' (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively. Only ten proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks. Conclusion Acute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. In contradistinction, acute zone 2 fractures demonstrate higher union rates and faster time to union when treated surgically. The outcomes of acute zone 3 fractures are rarely reported in the literature, so treatment recommendations remain unclear. Further research of proximal fifth metatarsal fractures is warranted to provide more definitive conclusions, but current findings can aid surgeons during the shared clinical decision making process. Level of evidence IV.

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Section: Outcome Measuresmentioning

confidence: 99%

Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

Rikken

Dahmen

Hagemeijer

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…A P value < 0.05 was considered statistically significant. All analyses were performed using STATA version 15.0 software (StataCorp, College Station, TX, USA) [22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of 1-year outcomes between MAKO versus NAVIO robot-assisted medial UKA: nonrandomized, prospective, comparative study

Leelasestaporn

Tarnpichprasert

Arirachakaran

et al. 2020

Knee Surg & Relat Res

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Background: We have conducted a prospective cohort study with the aim of comparing operative time, intraoperative blood loss, and radiologic and clinical outcomes between imageless (NAVIO) and image-based (MAKO) robot-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis (OA) of the knee. Methods: A total of 33 patients with medial compartment OA of the knee were prospectively allocated on alternate operative days of their surgery to MAKO (16 patients) or NAVIO (17 patients) robot-assisted UKA. The primary outcome (Knee Society Score [KSS] and Knee Functional Score [KFS]) and the secondary outcomes (intraoperative time of seven steps [registration of hip and ankle, femur and tibia, ligament tension, implant planning, preparation femur, tibia and trial implant], component alignment [coronal and sagittal of femur, tibia implant], blood loss, complications, and revision at 1 year after surgery) were compared between two groups. Statistical significance was set at P < 0.05. Results: Mean KSS measured at baseline and 1 year were, respectively, 70.3 (5.6) and 96.9 (5.7) in the NAVIO group and 72.3 (4.5) and 94.7 (10.01) in the MAKO group. Mean KFS measured at baseline and 1 year were, respectively, 95.5 (7.9) and 99.9 (0.25) in the NAVIO group and 67.3 (7.8) and 99.5 (1.2) in the MAKO group. There were no significant differences for KFS and KSS outcomes (P = 0.203 and P = 0.457, respectively) between the NAVIO and MAKO groups. Mean operative time and blood loss in the NAVIO versus MAKO robot-assisted UKA groups were 98 min versus 82.5 min and 136.3 ml versus 80 ml, respectively, and these differences were statistically significant. In the MAKO group, the intraoperative time was statistically significantly shorter in registration of hip and ankle center, femur and tibia, femur preparation, and trial implantation compared with the NAVIO group. There were no significant differences of component alignment and radiologic alignment at 1 year between the two groups. No perioperative or delayed complications (infection, periprosthetic fracture, thromboembolism, and compromised wound healing) and revisions were reported in either group. Conclusions: This study demonstrated that two robotic systems showed no difference in clinical outcomes at 1 year and radiologic alignment of implants, whereas operative time and intraoperative blood loss were found to be less in MAKO robot-assisted UKA. Trial registration: ClinicalTrials.gov, NCT03954912. Registered on 17 May 2019.

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“…According to P. Monteban et al [26] for the treatment strategies of pseudo-Jones metatarsal fracture can safely be treated non-operatively (full casting, backslab or bandaging) with good patient-reported outcome, less complications and re-interventions, lower healthcare cost, and without increased economic burden. Surgery can be reserved for those with delayed union after failed conservative treatment [26, 27]. There is a paucity of literature regarding non-operative treatment of Pseudo-Jones fractures of the fifth metatarsal base.…”

Section: Discussionmentioning

confidence: 99%

Comparative outcomes of foot cast and short leg cast in pseudo‐Jones avulsion fracture: a single blinded randomized controlled trial

Piyapittayanun

Mutthakalin

Arirachakaran

et al. 2019

Journal of Foot and Ankle Research

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Background Fractures of the metatarsal bones account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth metatarsal bone (pseudo-Jones) is by protected weight bearing. The methods of protected weight bearing include short-leg casting and splinting (boot cast, Jones’s bandage and elastic bandage). However, currently there is no consensus as to which method is the most suitable. Method We have conducted a randomized controlled trial to compare outcomes of foot casting (FC) and short leg casting (SLC) to assess pain, function and complication outcomes for the treatment of pseudo-jones metatarsal fractures. This single-center, single blind,randomized controlled trial was conducted between 1 June 2016–1 July 2018 at Police General Hospital, Bangkok, Thailand. Result A total of 72 pseudo-jones metatarsal fracture participants were randomly allocated to treatment by foot cast or short leg cast. The primary outcomes were pain VAS, AOFAS and complications measured at 2, 4, 6 and 8 weeks after receiving the treatment. Seventy-two patients (36 paticipants per group) were enrolled to receive either FC or SLC. The mean VAS measured at baseline, 2 weeks, 4 weeks, 6 weeks and 8 weeks were 7.36, 1.97, 0.58, 0.17 and 0.08 respectively in the FC group; and 6.09, 2.91, 1.23, 0.37 and 0.11 respectively in the SLC group. The mean AOFAS at baseline, 2, 4, 6 and 8 weeks were 33.60, 68.22, 82.72, 91.75 and 98.11 respectively in the FC group; and 32.60, 60.20, 70.20, 92.24 and 99.13 in the SLC group. The estimated mean difference of pain VAS and AOFAS at 2 weeks and 4 weeks were − 0.94 (95% CI: − 1.53, − 0.34), − 0.65 (95%CI: − 1.24, − 0.05), 8.02 (95%CI: 3.74, 12.10) and 12.52 (95%CI: 8.27, 16.78), which were statistically significantly better in the FC groups when compared to the SLC groups. However, there were no statistically significant difference between the two groups at 6 and 8 weeks. Conclusion This study demonstrated that the application of foot casting can improve pain VAS and AOFAS function at 2 and 4 weeks in the treatment of pseudo-jones metatarsal fractures when compared to short leg casting. However, at 6 and 8 weeks, there were no statistically significantly different between the two groups.

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Is nonoperative treatment still indicated for Jones fracture?

Abstract: Acute Jones fracture can be treated conservatively with good functional outcome.

Cited by 7 publications

References 13 publications

Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

Adequate union rates for the treatment of acute proximal fifth metatarsal fractures

Comparison of 1-year outcomes between MAKO versus NAVIO robot-assisted medial UKA: nonrandomized, prospective, comparative study

Comparative outcomes of foot cast and short leg cast in pseudo‐Jones avulsion fracture: a single blinded randomized controlled trial

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