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Several factors of high importance in treating of Jones fractures in athletes
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Jones fractures are fractures of the proximal fifth metatarsal metaphyseal-diaphyseal junction that are common in young athletic populations, particularly elite athletes. The poor blood supply to the fifth metatarsal has been well documented, and Jones fractures develop along a watershed area between the intramedullary nutrient and metaphyseal arteries. Surgical fixation is indicated in cases of failed nonoperative treatment, re-fracture, nonunion or when more rapid recovery is required typically in active individuals.
Nonoperative management using a non-weight bearing cast often requires prolonged immobilization (6 weeks to 8 weeks) and has a reported failure rate of up to 50% with a high incidence of delayed union, nonunion and/or re-fracture. Prospective, randomized study results have shown that early surgical fixation of acute Jones fractures has faster times to union and return to sports compared with cast treatment. As a result, acute surgical intervention for Jones fractures has become the mainstay of current treatment in athletes, military personnel and any patients desiring an early return to physical activity.
Our preference is to use a solid-core stainless steel screw system specifically designed for Jones fractures (Carolina Jones Fracture System; Wright Medical Technology Inc., Memphis, Tenn.) that has been shown to have a significantly higher fatigue resistance compared to cannulated screws with a good track record during the past 8 years. Three screw sizes are available (4.5 mm, 5.5 mm and 6.5 mm) with lengths from 40 mm to 70 mm, all of which have the same thread pitch that use a common instrument set for insertion.
Click here to read the Surgical Technique in the February issue of Orthopedics Today.