Jones Fracture Surgical Versus Nonsurgical Treatment

Josefsson, Per Olof; Karlsson, Magnus K.; Redlund-Johnell, Inga; Wendeberg, Bo

doi:10.1097/00003086-199402000-00035

Cited by 90 publications

(101 citation statements)

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“…These fractures are devastating to athletes because they are slow to heal and have a high potential for delayed union, nonunion, and refracture. 4,9,[14][15][16][17][18][19]26,28 These fractures can be acute, stress, or combined acute/stress fractures of the proximal portion of the fifth metatarsal. The Jones fracture 4,8 was first described by Jones in 1902 13 and involves the proximal third of the fifth metatarsal, distal to the insertion of the fibularis (peroneus) brevis tendon, 1.5 cm from the tuberosity of the fifth metatarsal (figure 1).…”

mentioning

confidence: 99%

Effects of Wearing Foot Orthosis With Medial Arch Support on the Fifth Metatarsal Loading and Ankle Inversion Angle in Selected Basketball Tasks

Yu¹,

Preston²,

Queen³

et al. 2007

J Orthop Sports Phys Ther

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Proximal fractures of the fifth metatarsal are most common in young male athletes. These fractures are devastating to athletes because they are slow to heal and have a high potential for delayed union, nonunion, and refracture. 4,9,[14][15][16][17][18][19]26,28 These fractures can be acute, stress, or combined acute/stress fractures of the proximal portion of the fifth metatarsal. The Jones fracture 4,8 was first described by Jones in 1902 13 and involves the proximal third of the fifth metatarsal, distal to the insertion of the fibularis (peroneus) brevis tendon, 1.5 cm from the tuberosity of the fifth metatarsal (figure 1). 5,7,8,16,23 Jones described the mechanism of injury in vivid terms: "so powerful are the ligaments that dislocation is rare. It is obviously easier to break the bone than to dislocate it." 13 The fifth metatarsal is subjected to 3-point bending (figure 1) when the foot lands in a relatively inverted position. Forces are imposed at the proximal end of the fifth metatarsal by the ground reaction force and soft tissues such as the fibularis brevis, lateral bands of the plantar fascia, and ligamentous/capsular tissue between the cuboid and the base of the fifth metatarsal. Force is also imposed by the ground reaction force at the distal end of the metatarsal as a result of the foot being in a relatively inverted position. Finally, the base of the fourth metatarsal applies a force in response to the previously described forces, completing the 3-point bending stress that may produce a stress fracture in response to cumulative fatigue, an acute fracture following sufficiently high-magnitude loading, or a combination of the two. Weight bearing that occurs with the foot in an inverted position, therefore, tends to promote the t studY design: Preintervention and postintervention, repeated-measures experimental design.t oBJectives: The objective was to investigate the effects of foot orthoses with medial arch support on ankle inversion angle and plantar forces and pressures on the fifth metatarsal during landing for a basketball lay-up and during the stance phase of a shuttle run.t Background: Proximal fractures of the fifth metatarsal, specifically the Jones fracture, are common in sports. Wearing foot orthoses with medial arch support could increase the ankle inversion angle and the plantar forces and pressure on the fifth metatarsal that may increase the risk for fifth metatarsal fracture.t MetHods and Measures: Three-dimensional (3-D) videographic, force plate, and in-shoe plantar force and pressure data were collected during landing after a basketball lay-up and during the stance phase of a shuttle run with and without foot orthoses with medial arch support for 14 male subjects. Two-way ANOVAs with repeated measures were performed to compare ankle inversion angle, maximum forces, and pressure on the fifth metatarsal head and base between conditions and between tasks.t results: The maximum ankle inversion angle and maximum plantar force and pressure on the base of the fifth metatarsal during both ...

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confidence: 99%

Effects of Wearing Foot Orthosis With Medial Arch Support on the Fifth Metatarsal Loading and Ankle Inversion Angle in Selected Basketball Tasks

Yu¹,

Preston²,

Queen³

et al. 2007

J Orthop Sports Phys Ther

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“…In view of the high failure rate of nonsurgical treatment, the author suggested that early fixation of the fracture was the preferred method of managing Jones fracture. A study by Joseffson et al [6] reported that as many as 12% of acute Jones fractures treated nonsurgically required later surgical treatment because of delayed union. This series consisted mainly of athletes (71%) with a mean age of 28 ± 13 years.…”

Section: Discussionmentioning

confidence: 99%

“…This is due to reports of highly unpredictable union rates upon nonsurgical treatment [4][5][6][7], and studies which show that a better outcome is obtained with surgical treatment of acute Jones fracture [3,6,[8][9][10][11][12]. Excellent results have been achieved with the fixation of acute Jones fractures using intramedullary screws [3,5,6,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Is nonoperative treatment still indicated for Jones fracture?

Chiu

Vivek

2009

Eur J Trauma Emerg Surg

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“…This way, stable Wxation and early weight-bearing is possible including a very-high and fasthealing time. Especially in high demand, young, sports active patients an operative treatment has to be favored as non-union rate in non-operative patients is signiWcantly higher [2,12,17] and secondary treated fractures need a more invasive surgical technique [18]. Alternatively to screw Wxation, Wxation with a bicortical screw in avulsion type fractures [19], and tension band wiring in small fragment fractures [20] is an option.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

Leumann

Pagenstert

Fuhr

et al. 2008

Arch Orthop Trauma Surg

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Introduction and purpose Intramedullary screw Wxation (ISF) of proximal Wfth-metatarsal fractures is known as Wrst treatment option in young, sports active patients. No study analyzed functional and biomechanical outcome before. Hypothetically ISF leads to (1) a high bony union rate within 12 weeks, (2) normal hindfoot eversion strength, and (3) normal gait and plantar pressure distribution. Methods Fourteen out of 22 patients were available for follow-up with an average follow-up of 42 months; clinical and radiological follow-up, and biomechanical evaluation by isometric muscular strength measurement (inversion, eversion strength) and dynamic pedobarography, comparing to the non-aVected contralateral foot. Level of signiWcance: 0.05. Results Subjective result: Excellent or good result in 14 patients, none fair or poor. AOFAS midfoot score: 100 points in 13 patients and 87 points in 1 patient. The same sports activity level (0-4) was reached in 13 out of 14 patients. Radiologic examination: consolidation after 6 weeks in 9 patients and after 12 weeks in another 4 patients, one partial union. Average maximal eversion strength 59 N (ratio to the contralateral foot: 0.92, not signiWcant). Dynamic pedobarography showed ratios of 0.99-1.01 to the contralateral side for ground reaction force, ground peak time, peak pressure and contact area (not signiWcant). Interpretation A very-high patient-satisfaction, a fast bony healing and complete return to sports were documented. Muscular strength measurement and dynamic pedobarography showed complete functional rehabilitation. Therefore, ISF in proximal Wfth-metatarsal fractures can be recommended as a secure procedure.

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Jones Fracture Surgical Versus Nonsurgical Treatment

Cited by 90 publications

References 0 publications

Effects of Wearing Foot Orthosis With Medial Arch Support on the Fifth Metatarsal Loading and Ankle Inversion Angle in Selected Basketball Tasks

Effects of Wearing Foot Orthosis With Medial Arch Support on the Fifth Metatarsal Loading and Ankle Inversion Angle in Selected Basketball Tasks

Is nonoperative treatment still indicated for Jones fracture?

Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

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