Refracture of Proximal Fifth Metatarsal (Jones) Fracture After Intramedullary Screw Fixation in Athletes

Abstract

This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.

Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

“…Several studies have suggested acute forefoot injury as the cause of Jones fractures, whereas physiologic repetitive stress injury is most likely responsible for proximal diaphyseal fractures of the fifth metatarsal [4,17,19,22]. However, all of these studies lack appropriate statistical analysis.…”

“…The Jones fracture initially was described by Sir Robert Jones in 1902 [7], and a review of his article showed both fracture types are included in his clinical cases and radiographs. More recent literature defines differences in diagnosis and prognosis between acute Jones and proximal diaphyseal stress fractures [11,[20][21][22]. A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation [11].…”

“…A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation [11]. The mechanism of injury is believed to be an abduction force applied to the forefoot with simultaneous ankle plantar flexion [3,17,19,22]. A proximal diaphyseal fifth metatarsal stress fracture is defined as a stress fracture in the zone of the proximal fifth metatarsal immediately distal to the Jones fracture's anatomic area [4].…”

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

“…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).…”

Stress fractures in the foot and ankle of athletes

“…55 Running shoes with neutral insoles have recently demonstrated a statistically significant reduction in plantar pressure in athletes with cavus feet (A). 56 In relation to refracture, it is well known that returning to sport early is an important risk, therefore athletes should be warned about the complication (C). 47,57 In high level athletes, computerized tomography or magnetic resonance imaging should be considered before returning to training in order to avoid refracture (C).…”