Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures

Naval Medical Center San Diego, San Diego, California, United States
The American Journal of Sports Medicine (Impact Factor: 4.36). 08/2005; 33(7):970-5. DOI: 10.1177/0363546504272262
Source: PubMed


There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures.
Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment.
Randomized controlled clinical trial; Level of evidence, 1.
Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient.
Mean follow-up was 25.3 months (range, 15-42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with P < 001.
There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.

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    • "The study by Dameron in 1975 was one of the first to suggest that the proximal fifth metatarsal fracture should have a therapeutic approach according to the patient's level of activity.9 Other authors subsequently reinforced this assumption, reporting important rates of refracture, delay in consolidation and prolonged recovery times in athletes with fractures treated conservatively.10 Clapper et al.11 described a rate of nonunion in 28% of the patients treated for eight weeks with plaster cast immobilization without bearing weight on the affected limb. "
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    ABSTRACT: The purpose of this study was to review the short- and long-term clinical and radiological results of intramedullary compression screw fixation of proximal fifth metatarsal fractures in athletes. Eleven male and six female active patients with fifth metatarsal zone II and zone III fractures fixed with a 4.5-mm cannulated compression screw were evaluated by chart review, review of radiographs, and clinical evaluation. Fifteen of the patients were high-level athletes (soccer: n=11; basketball: n=1; track and field: n=3) and two were recreational-level athletes. Mean follow-up from surgery to evaluation was 54 (38-70) months. Mean time to healing as shown on radiographs and mean time to return to full activity after surgery were 7.3 and 7.5 weeks, respectively. All patients were able to return to their previous levels of activity. There were no reports of union delay, nonunion or refracture to date. In our patients, cannulated screw fixation of proximal fifth metatarsal fractures was a reliable procedure with low morbidity associated that provided athletes a quick return to activity. Level of Evidence I, Case Series .
    Full-text · Article · Mar 2012 · Acta Ortopédica Brasileira
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    • "It is of utmost importance to distinguish between the acute fractures and the diaphyseal stress fractures for proper management.7) Undisplaced zone I and zone II fractures usually respond well to conservative treatment; however, operative fixation of the displaced zone II fractures and the displaced intraarticular zone I fractures has shown better results than conservative treatment.6,8-10) To date, no clinical study has evaluated the effectiveness of percutaneous bicortical screw fixation for these fractures. "
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    ABSTRACT: Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.
    Full-text · Article · Jun 2011 · Clinics in orthopedic surgery
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    • "Surgical fixation of transverse proximal diaphyseal fractures results in a quicker recovery time for radiographic union and a quicker return to normal activity, compared with cast immobilization [31]. With internal fixation, patients can return to full activity levels 6 to 8 weeks postoperatively [30] [31]. The percutaneous technique for fixation of a transverse proximal diaphyseal fracture is identical to the technique mentioned previously for fifth metatarsal tuberosity avulsion fractures. "
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    ABSTRACT: Open reduction with rigid internal fixation is the basic principle for surgical management in foot and ankle trauma. High-risk patients present a surgical dilemma for the foot and ankle surgeon because the possible complications are magnified in this patient population. Percutaneous fixation is a unique alternative for achieving anatomic stabilization without increased physical strain to the patient. The significant advantages of percutaneous fixation include minimizing damage to the vascular supply, maintaining and preserving a stable soft tissue envelope, and decreasing the potential risk for infection. This article provides an overview of percutaneous surgical fixation methods and their role in foot and ankle trauma for the high-risk patient.
    Full-text · Article · Nov 2008 · Clinics in Podiatric Medicine and Surgery
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