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

Abstract

Background: Although the benefit of primary intramedullary (IM) screw fixation of fifth metatarsal Jones fractures in athletes is clear, limited data support its use in conventional patient populations. This study evaluated radiographic and functional outcomes following primary IM screw fixation in a series of Jones fractures to determine if similar excellent outcomes were achievable. Methods: We reviewed the data of 32 consecutive patients who underwent Jones fracture primary IM screw fixation by a single surgeon. Demographic risk factors of interest (age, gender, tobacco use, pertinent medical comorbidities, military service status, and prior nonoperative management) were collected prospectively. Primary outcomes included times to return to full weightbearing, radiographic union, and resumption of high-impact or restriction-free activities. Complications including reoperations were recorded. Categorical data are reported as frequencies, and statistical means with P values are reported for continuous variables. Mean age for the 32 patients was 33.4 years. Results: All 32 fractures healed uneventfully, and at mean follow-up time of 24.2 months, overall patient-reported satisfaction was 100%. Overall mean postoperative outcomes are as follows: 3.7 weeks return to full weightbearing, 10.8 weeks to radiographic union, and 13.0 weeks to resumption of restriction-free activities. Among the risk factors assessed, only preoperative peripheral vascular disease (PVD) and/or diabetes mellitus (DM) and active duty military service resulted in significantly increased and decreased time to resumption of restriction-free activities, respectively, but did not impact overall weightbearing or union times. Patient age, gender, and tobacco use had no effects on radiographic or functional outcomes. Conclusion: Primary IM screw fixation was a safe, reliable option for all appropriate operative candidates with Jones fractures and may result in similar early weightbearing, osseous healing, and expeditious return to full activities consistently reported in high-level athletes. Level of Evidence: Level IV, case series.

Rate of Delayed Union With Early Weightbearing Following Intramedullary Screw Fixation of Jones Fractures

“…The current study’s design was not optimized for a continuous analysis of fracture healing, such as that typically employed by other authors, 4,7,16,23,26,28,37,39 which makes a direct comparison to previously reported measures of central tendency for union times unreliable. However, since patients in the present cohorts had follow-up in addition to the standardized visits that were used for the primary ordinal analysis, we did report median healing times to facilitate some comparison of our results to other studies.…”

“…These values are consistent with previously published results on the time to radiographic and clinical union in operatively managed fifth metatarsal base fractures. 4,18,22,37…”

“…Interestingly, although radiographic and biomechanical studies have suggested that larger, solid intramedullary screws may be more effective in the management of Jones fracture fixation, our analysis did not find that screw diameter affected time to union or likelihood of delayed union. 10,17,24,25 The current study's design was not optimized for a continuous analysis of fracture healing, such as that typically employed by other authors, 4,7,16,23,26,28,37,39 which makes a direct comparison to previously reported measures of central tendency for union times unreliable. However, since patients in the present cohorts had follow-up in addition to the standardized visits that were used for the primary ordinal analysis, we did report median healing times to facilitate some comparison of our results to other studies.…”

“…Given the gaps in observation that are an unfortunate but characteristic feature of serial radiographic follow-up, a continuous analysis was not considered appropriate, despite this being common practice. 4,7,16,18,23,[26][27][28]37,39 Similarly, a purely nominalizing categorical model (eg, χ 2 ) was considered inadequate given the nature of the outcome variable. We thus selected an ordinal approach for the primary analysis using a cumulative link proportional odds model to examine the effect of EWB vs DWB on fracture healing by the end of the 6th postoperative week, between the end of the 6th postoperative week and the 12-week follow-up, and beyond, which constituted a delayed union as previously defined.…”

“…With the benefit of recently published data, we estimated that the expected probability of achieving fracture healing following IM screw fixation with at least 2 weeks delayed weightbearing was .09375 by the end of the 6th postoperative week, while the probability of achieving healing between the end of the 6th week and the 12.65-week mark was .53125, and the probability of healing after that was .37500. 4 These probabilities were used as the baseline probabilities for a hypothetical DWB reference group. They were also entered as the respective sampling probabilities for each of the 3 ordinal outcome levels (ie, healed by end of 6th week, healed between end of 6th week and 12.65 weeks, and delayed union), which were sampled 10,000 times to produce a simulated data set that was evaluated in an intercepts-only proportional odds model.…”