Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

Abstract

Background:Jones fractures result in subsequent dysfunction and remain an issue for athletes.Purpose:To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players.Study Design:Cohort study; Level of evidence, 3.Methods:All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed.Results:Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls (P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2).Conclusion:Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

Return to Weightbearing and High-Impact Activities Following Jones Fracture Intramedullary Screw Fixation

“…Surgeons must be cognizant of the risk of refracture, particularly in dealing with high-demand populations, and avoid the temptations to return patients back to high-impact activities before radiographic union. 1,13,17,19,24,28 As an example in our series, military service members were released by the senior author to high-impact activities earlier than nonmilitary patients. Not surprisingly, we identified 3 military service members who returned to running activities prior to complete radiographic healing.…”

“…1,5,9,12,14,18,19 The preponderance of recent studies reporting outcomes after Jones fracture IM screw fixation focus primarily on high-level, often "elite," athletes and their return to restriction-free sporting activities. 7,10,12,13,18,19,24,25,28 Sparse studies to date focus on the results of primary IM screw fixation for nonelite athletic cohorts, and more specifically, for populations that might be at risk for delayed union or nonunion with traditional conservative management. A systematic review of mostly Level IV evidence demonstrated dramatically improved pooled union rates in Jones fractures treated with early IM screw fixation compared to those treated nonoperatively (96% vs 76%, respectively) across all groups of patients.…”

A novel method for internal fixation of basal fifth metatarsal fracture in athletes: a cadaveric study of the F.E.R.I. technique (Fifth metatarsal, Extra-portal, Rigid, Innovative)

“…These make up approximately 70% of all metatarsal fractures (Petrisor et al 2006), both in the general population and also in athletes. In an interesting review, Spang RC et al (Spang et al 2018) have found that the overall percentage of fifth metatarsal base fractures in NFL players was 3.2%. Fifth metatarsal fractures are an increasing problem, particularly in athletes.…”

Outcomes of Surgically Treated Fifth Metatarsal Fractures in Major League Soccer Athletes

“…Despite surgical fixation, there is still risk for fixation failure, nonunion, and/or refracture. Studies examining athletes with sports-related fifth metatarsal fractures have been performed in multiple professional sports including basketball, 1,24 American football, 16 American collegiate football, 3,33,36 and European professional soccer. 8 However, no study has examined stress-related fifth metatarsal fractures in Major League Soccer (MLS) athletes.…”