Return to Play in National Football League Players After Operative Jones Fracture Treatment

Abstract

Background: Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. The purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. Operative treatment for the majority of patients involved fixation with a Jones-specific intramedullary screw and iliac crest bone marrow aspirate with demineralized bone matrix injected at the fracture site. Additionally, our protocol involved the use of noninvasive bone stimulators, application of customized orthoses, and an aggressive patient-specific rehabilitation protocol. Patient demographics were recorded along with position played, seasons played after surgery, RTP, and complications. RTP was defined as the ability to play in a single regular-season NFL game after surgery. At the time of surgery, average age for all patients was 24.0 years and BMI 31.0. Results: Player positions included 8 wide receivers, 4 linebackers, 4 tight ends, 2 defensive tackles, 2 cornerbacks, 1 offensive tackle, 1 center, 1 tackle, 1 defensive end, and 1 quarterback. Seventy-six percent of players underwent operative fixation during their first 3 seasons. Forty-eight percent were diagnosed before or during their rookie (first) season. RTP was 100% for all players and 80% were still playing at time of publication. Three patients (12.0%) refractured and required revision surgery. Time until RTP was influenced by other variables and difficult to measure because many surgeries were performed early in the offseason. All 9 players who underwent surgery between July and October, and were therefore eligible to return to play in the same season, had an average RTP of 8.7 weeks (range 5.9-13.6). Conclusion: With an appropriately placed intramedullary screw and an aggressive rehabilitation protocol, early RTP was achievable with a low refracture rate in professional athletes. All NFL players in this series were able to return to play after surgery. We observed that these injuries were more likely to occur in the first 3 seasons of play and in wide receivers, linebackers, and tight ends. This at-risk subset of players may benefit from improved preventative measures. Level of Evidence: Level IV, retrospective case series.

Evaluation of Two Types of Intramedullary Jones Fracture Fixation in a Cyclic and Ultimate Load Model

“…Surgical preparation of the intramedullary canal was carried out according to the manufacturer's proposed technique. A 2.0 mm guide wire was inserted “high and inside” by direct visualization and orientation, inspired by previously published anatomical landmarks . Afterward a 3.5 mm drill guide was introduced over the guide wire and a 3.5 mm cannulated drill was advanced into the proximal aspect of the fifth metatarsal.…”

“…During taping the appropriate screw size and length was measured. The required screw length was estimated as about 70% of the metatarsal length and selected by visual inspection superimposing the screw over the metatarsal . Care was taken that the screw was not too long, preventing lateral fracture site gapping, but long enough that threads were distal to the fracture site.…”

“…Jones fractures or proximal fifth metatarsal fractures (Zone II and III) are common injuries in competitive and recreational athletes . In addition to the high incidence of symptomatic delayed unions and non‐unions when treated conservatively, a long time of immobilization is undesirable for an active patient . Therefore, a primary surgical approach has been advocated, especially in the athletic population .…”

“…Intramedullary screw fixation emerged as gold standard treatment with good to excellent clinical results during the last decades . Patients benefit from a minimally invasive surgical approach, a more expeditious return to sports and competition, and of higher union rates . The aim of surgical Jones fracture fixation in the elite athlete is to enable a fast return to play, which indicates that surgical fixation should withstand an early weight‐bearing regimen.…”

Forefoot Adduction Is a Risk Factor for Jones Fracture

“…DeLee et al (1983) and Raikin and colleagues (2008) both found a relationship between proximal fifth metatarsal fractures and hindfoot varus deformity, implicating excess lateral column loading as a possible etiology (3,5). Similarly, certain sports (e.g., basketball and football) which involve large amounts of pivoting may also be associated with an increased risk for developing Jones fractures (6,7). This is thought to be due to the excess stress placed on the lateral side of the forefoot while the ankle is somewhat plantar flexed during pivoting maneuvers (5,8).…”