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Klug P, Adams J, Lents G, Long R, Herda A, Vopat B, Vopat L. Auditing the Representation of Female Athletes in Sports Medicine Research: Fifth-Metatarsal Fractures. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241318. [PMID: 38584819 PMCID: PMC10996359 DOI: 10.1177/24730114241241318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Female representation within athletics has increased as a result of Title IX, rising popularity, demand for equal compensation, and greater participation in multiple sports. Despite this, gender disparities in sports medicine research are apparent. This project serves to review the literature available on fifth-metatarsal fractures and assess the representation of female athletes in current literature. Methods We used a standardized protocol to audit the representation of female athletes in sports science and sports medicine research for fifth-metatarsal fractures. Primary factors included population, athletic caliber, menstrual status, research theme, sample of males and females, journal impact factor, and Altmetric score. Results Thirty articles met the inclusion criteria. A total of 472 fifth-metatarsal fractures were identified, with 373 of 472 fractures (79%) occurring in males and 99 of 472 (21%) in females. The majority of studies (18/30, 60%) were mixed cohort, followed by 10 male only (33.33%), 1 female only (3.33%), and 1 male vs female (3.33%). Out of 831 total patients in the 18 mixed-cohort studies, 605 of 831 patients (72.8%) were male and 226 of 831 patients (27%) were female. All 18 mixed-sex cohorts investigated health outcomes. Male-only studies evaluated health outcomes and performance metrics. No studies investigated female performance. The one female-only study investigated health outcomes and was the only study to account for menstrual status. There was a single metatarsal fracture in this study population. Conclusion Females are underrepresented in research regarding sports science and sports medicine research for fifth-metatarsal fractures. Research focused on female-only fifth-metatarsal fracture studies exploring the potential impact of female sex-specific factors such as menstrual status in study design are needed.
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Affiliation(s)
- Peter Klug
- Kansas University Medical Center, Kansas City, KS, USA
| | - Jacob Adams
- Kansas University Medical Center, Kansas City, KS, USA
| | - Gordon Lents
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Rachel Long
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Ashley Herda
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Lisa Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
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2
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Attia AK, Robertson GAJ, McKinley J, d'Hooghe PP, Maffulli N. Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures. Am J Sports Med 2022:3635465221094014. [PMID: 35612823 DOI: 10.1177/03635465221094014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated. PURPOSE To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone). RESULTS In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; I2 = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; I2 = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I2 = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; I2 = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; I2 = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; I2 = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I2 = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I2 = 98.81%). CONCLUSION Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation.
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Affiliation(s)
| | | | | | | | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Italy
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3
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Look N, Reisenauer CR, Gorman MA. Conservative management of Jones fractures with immediate weight-bearing in a walking boot demonstrates healing. Foot (Edinb) 2022; 50:101870. [PMID: 35219132 DOI: 10.1016/j.foot.2021.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023]
Abstract
Jones fractures, or proximal metatarsal fractures at the level of the fourth and fifth intermetatarsal junction, have a high risk for nonunion due to a vascular watershed region. Classically, treatment consists of weight bearing restrictions in a cast or surgical fixation. Some studies have assessed immediate weight bearing following a Jones fracture. Due to conflicting results, the most appropriate treatment method remains unclear. This study analyzes outcomes after treating adults with acute Jones fractures non-operatively without weight bearing restrictions in a walking boot. This study hypothesizes that patients will not require future operative intervention following functional treatment. A retrospective review of 55 adult patients who sustained acute, closed Jones fractures was conducted. 47 were treated weight bearing as tolerated (WBAT) in a walking boot and eight were treated non-weight bearing (NWB) in a cast. They were followed radiographically by an orthopedic surgeon for an average of 6.4 and 15.5 months, respectively. Three patients in each group (6.4% WBAT, 37.5% NWB) developed painful nonunion leading to surgical fixation. Thirty (66.7%) patients in the WBAT group demonstrated radiographic union on final radiographs. Only two (13.3%) of the 15 patients with partial union were seen at least six months from time of injury, one of whom had ongoing pain but declined surgery. The remaining 13 patients were asymptomatic at their final clinic appointment. Controversy still exists as to the best treatment methodology for acute Jones fractures. Due to a lack of clear guidelines, it can be difficult for the multiple medical specialties involved to evaluate and treat this injury. Our study suggests that non-operative management of minimally displaced Jones fractures, in the adult, low demand population, without weight bearing restrictions in a walking boot offers similar outcomes to cast immobilization with weight bearing restrictions, resulting in bony union or asymptomatic fibrous nonunion.
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Affiliation(s)
- Nicole Look
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Center, 13001 East 17thAvenue, Aurora, CO, United States.
| | - Colin R Reisenauer
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Center, 13001 East 17thAvenue, Aurora, CO, United States.
| | - Melissa A Gorman
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Center, 13001 East 17thAvenue, Aurora, CO, United States.
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4
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Bezuglov E, Zholinsky A, Chernov G, Khaitin V, Goncharov E, Waśkiewicz Z, Barskova E, Lazarev A. Conservative Treatment of the Fifth Metatarsal Bone Fractures in Professional Football Players Using Platelet-Rich Plasma. Foot Ankle Spec 2022; 15:62-66. [PMID: 34142576 DOI: 10.1177/19386400211017368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Injuries of the metatarsal bones in football are relatively rare and in most cases are localized in the fifth metatarsal. The gold standard of the diagnosis of fractures in this area can be X-rays, which in most cases allows verifying the diagnosis. The treatment tactics depend on the localization of the fracture according to Lawrence and Botte's classification: 3 zones of localization are distinguished. Fractures located in zones 2 and 3 belong to a high-risk group due to delayed consolidation and nonunion and therefore athletes are most often treated with osteosynthesis using intramedullary screws. The minimal recovery time for this type of treatment is at least 8 weeks. This report describes 7 cases of the fifth metatarsal bone fractures, located in zones 2 and 3 in professional football players who were treated with an immobilization boot, cryotherapy, nutritional supplements of calcium and vitamin D, and local injections of platelet-rich plasma, which contains numerous growth factors. The deadline for returning to regular training activities was 43 to 50 days, and there was no relapse of damage within 6 months of follow-up.Levels of Evidence: Level of evidence 4: case report study.
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Affiliation(s)
- Eduard Bezuglov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Russian Football Union, Moscow, Russian Federation.,Federal Research and Clinical Center of Sports Medicine and Rehabilitation, Federal Medical Biological Agency, Moscow, Russian Federation
| | - Andrey Zholinsky
- Federal Research and Clinical Center of Sports Medicine and Rehabilitation, Federal Medical Biological Agency, Moscow, Russian Federation
| | | | | | - Evgeniy Goncharov
- Russian Medical Academy of Continuous Professional, Moscow, Russian Federation.,Traumatology and Orthopedics Center, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Zbigniew Waśkiewicz
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Ekaterina Barskova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,High Performance Sports Laboratory, Moscow Witte University
| | - Artemii Lazarev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,High Performance Sports Laboratory, Moscow Witte University.,A.I. Burnazyan Federal Medical and Biophysical Center, Federal Biomedical Agency of Russia, Moscow, Russian Federation
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5
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Attia AK, Taha T, Kong G, Alhammoud A, Mahmoud K, Myerson M. Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:3422-3436. [PMID: 33740393 DOI: 10.1177/0363546521990020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population. PURPOSE To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures. STUDY DESIGN Meta-analysis. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures. RESULTS Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; P < .001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%). CONCLUSION The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes.
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Affiliation(s)
| | - Tarek Taha
- Weill Cornell Medical College, Doha, Qatar
| | - Geraldine Kong
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Karim Mahmoud
- Department of Orthopaedics, Emory University Hospital, Atlanta, Georgia, USA
| | - Mark Myerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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6
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Albloushi M, Alshanqiti A, Qasem M, Abitbol A, Gregory T. Jones type fifth metatarsal fracture fixation in athletes: A review and current concept. World J Orthop 2021; 12:640-650. [PMID: 34631448 PMCID: PMC8472442 DOI: 10.5312/wjo.v12.i9.640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.
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Affiliation(s)
- Mohammad Albloushi
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Amer Alshanqiti
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Mohammad Qasem
- Al-Razi Hospital, Ministry of Health, State of Kuwait, Kuwait City 00965, Kuwait
| | - Andreas Abitbol
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Thomas Gregory
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
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7
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The Fifth Metatarsal Bone Fracture in Athletes - Modalities of Treatment Related to Agility in Soccer Players. J Hum Kinet 2021; 79:101-110. [PMID: 34400990 PMCID: PMC8336555 DOI: 10.2478/hukin-2020-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 5th metatarsal fracture is a common foot fracture which could exclude a player from competition for several months and significantly affect his or her career. This manuscript presents the treatment and rehabilitation of professional soccer players who had acute fractures of the 5th metatarsal bone and a cannulated screw fixation. The main purpose of the analysis was to determine the minimum time necessary for a permanent return to the sport after a 5th metatarsal fracture among professional soccer players. We followed the surgical and rehabilitation path of 21 professional soccer players from the Polish League (Ist and IInd divisions) who suffered from the 5th metatarsal bone fracture. All players underwent standard percutaneous internal fixation with the use of cannulated screws. The total inability to play lasted for 9.2 (± 1.86) weeks among players treated only surgically (n = 10), 17.5 (± 2.5) weeks in the conservative and later surgery group, excluding players with nonunion (n = 6), and 24.5 (± 10.5) weeks for nonunion and switch treatment (n = 4) players. Prompt fracture stabilization surgery is recommended for athletes, enabling the implementation of an aggressive rehabilitation protocol as soon as possible. Early limb loading after surgery (from week 2) does not delay fracture healing or hinder the bone union, thus rehabilitation plays a crucial role in shortening the time of RTP (return to play) and is obligatory for each athlete who undergoes surgical treatment.
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8
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Umbel BD, Sharpe BD, Hockman T, Philbin TM. Early Results of a Novel Intramedullary Fixation Device for Proximal Fifth Metatarsal Fractures. Foot Ankle Spec 2021; 16:113-120. [PMID: 34142583 DOI: 10.1177/19386400211016948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proximal fifth metatarsal fractures are commonly treated surgically due to their poor healing capacity. While intramedullary screws may be the most popular operative treatment choice, newer fixation methods continue to develop. We present a case series utilizing a novel intramedullary fixation device for proximal fifth metatarsal fractures. To our knowledge, no other study in the literature has assessed the safety and efficacy of this fixation method. METHODS A retrospective analysis was performed for 16 patients with proximal fifth metatarsal fractures who underwent fixation with the same novel intramedullary device. Patient charts were reviewed for fracture union, plantar fracture gapping, time to weight-bearing, refracture, perioperative complications, and secondary surgeries. RESULTS Sixteen patients with an average age of 43.3 years underwent fixation with this novel device from 2015 to 2020. Mean follow-up was 32.4 weeks. Fifteen of the 16 patients achieved radiographic union at a mean of 8.9 weeks. One patient suffered a nonunion. Mean time to full weight-bearing in, and out of, a walking boot was 6.4 and 9.8 weeks, respectively, for healed fractures. Mean plantar fracture gap improved from 1.22 mm to 0.88 mm following surgery. There were zero infections, refractures, or hardware complications. Three patients suffered iatrogenic fracture during implant insertion. CONCLUSION To our knowledge, this is the first report of early results for this novel intramedullary device. Excellent union rates, acceptable time to weight-bearing, and a low complication profile can be achieved. Based on our findings, we propose a safe and effective treatment option for proximal fifth metatarsal fractures. LEVELS OF EVIDENCE Level IV: Clinical case series.
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9
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Jones fractures outcome measurement: a case series. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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van Dijk PA, Breuking S, Guss D, Johnson H, DiGiovanni CW, Vopat B. Optimizing surgery of metaphyseal-diaphyseal fractures of the fifth metatarsal: a cadaveric study on implications of intramedullary screw position, screw parameters and surrounding anatomic structures. Injury 2020; 51:2887-2892. [PMID: 32998823 DOI: 10.1016/j.injury.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
AIMS Many advocate screw fixation of fractures to the metaphyseal-diaphyseal junction of the fifth metatarsal base, better known as Jones fractures (JF), to facilitate quicker ambulation and return to sport. Maximizing screw parameters based on fifth metatarsal (MT5) anatomy, alongside understanding the anatomic structures compromised by screw insertion, may optimize surgical outcomes. This study aims to (1) correlate the proximity of JF to the peroneus brevis (PB) and plantar fascia (PF) footprints and (2) quantify optimal screw parameters given MT5 anatomy. MATERIALS AND METHODS 3D CT-scan reconstructions were made of 21 cadaveric MT5s, followed by meticulous mapping of the PB and PF onto the reconstructions. Based on bone length, shape, narrowest intramedullary canal (IMC) diameter, and surrounding anatomy, two traditional debated screw positions were modeled for each reconstruction: (1) an anatomically positioned screw (AP), predicated on maximizing screw length by following the IMC for as long as possible, and (2) a clinically achievable screw (CA), predicated on maximizing screw length without violating the fifth tarso-metatarsal joint or adjacent cuboid bone. Fixation parameters were calculated for all models. RESULTS The PB and PF extended into the JF site in 29% and 43%, respectively. AP's did not affect PB and PF footprint but required screw entry through the cuboid and fifth tarso-metatarsal joint in all specimens. CA screw entry sites, avoiding the cuboid and fifth tarso-metatarsal joint, partially compromised the PB and PF insertions in 33% and 62% with a median surface loss of 1.6%%(range 0.2-3.2%) and 0.81%%(range 0.05-1.6%), respectively. Mean AP screw length was 64±3.6mm and thread length 49±4.2mm. Mean CA screw length was 48±5.8mm and thread length 28±6.9mm. CONCLUSION This study underscores the challenges associated with surrounding MT5 anatomy as they relate to optimal JF treatment. Both the extent of JF as well as a clinically achievable positioned screw violate the PB and PF footprints - although the degree to which even partial disruption of these footprints has on outcome remains unclear. To minimize damage to surrounding structures, including the PB and PF footprint, while allowing a screw length approximately two thirds of the metatarsal length, the CA screw position is recommended. This position balances the desire to maximize pull out strength while avoiding cortical penetration or inadvertent fracture site distraction.
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Affiliation(s)
- P A van Dijk
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA.
| | - S Breuking
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA
| | - D Guss
- Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA
| | - H Johnson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - C W DiGiovanni
- Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA
| | - B Vopat
- Department of Sports Medicine and Orthopedics, University of Kansas Medical Center, Kansas City, KS, USA
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11
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Looney AM, Renehan JR, Dean DM, Murthy A, Sanders TH, Neufeld SK, Cuttica DJ. Rate of Delayed Union With Early Weightbearing Following Intramedullary Screw Fixation of Jones Fractures. Foot Ankle Int 2020; 41:1325-1334. [PMID: 32691621 DOI: 10.1177/1071100720938317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Jones fractures of the proximal fifth metatarsal are predisposed to delayed union and nonunion due to a tenuous blood supply. Solid intramedullary (IM) screw fixation is recommended to improve healing, traditionally followed by delayed weightbearing (DWB). However, early weightbearing (EWB) postoperatively may facilitate functional recovery. The purpose of this study was to compare union rates and time to union after solid IM screw fixation of Jones fractures in patients treated with an EWB protocol to those treated with a DWB protocol, as well as to identify any factors that may be predictive of delayed or nonunion. METHODS True Jones (zone 2 fifth metatarsal base) fractures treated from April 2012 through January 2018 with IM screw fixation and 6 months follow-up were identified (41 fractures in 40 patients; mean ± SD age, 45.3 ± 17.9 years). Patients were divided into EWB and DWB cohorts (within or beyond 2 weeks, respectively). Delayed union (12.5 weeks) was statistically derived from established literature. Union times were compared between cohorts. Regression analyses were conducted to investigate possible confounders contributing to delayed union. There were 20 fractures in the EWB cohort and 21 fractures in the DWB cohort. RESULTS There was no significant difference in healing times (EWB: 25% by 6th week, 55% by the 12th week, 20% delayed; DWB: 33% by 6th week, 43% by 12th week, 24% delayed; P = .819) or delayed unions (EWB, 20% vs DWB, 24%; P > .999). There were no nonunions. No significant confounding risk factors were identified. CONCLUSION Postoperative protocols using early weightbearing following solid IM screw fixation of Jones fractures appear to be safe and do not delay fracture healing or increase the risk of delayed union. Older age may be a risk for delayed union, but larger studies are needed to evaluate this with appropriate power in light of possible confounders. EWB protocols may allow better functional recovery without compromising outcomes by increasing the risk of delayed union. LEVEL OF EVIDENCE Therapeutic level III, retrospective comparative study.
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Affiliation(s)
| | | | | | - Anu Murthy
- Georgetown University Hospital, Washington, DC, USA
| | - Thomas H Sanders
- The Centers for Advanced Orthopaedics, Orthopaedic Foot and Ankle Center, Falls Church, VA, USA
| | - Steven K Neufeld
- The Centers for Advanced Orthopaedics, Orthopaedic Foot and Ankle Center, Falls Church, VA, USA
| | - Daniel J Cuttica
- The Centers for Advanced Orthopaedics, Orthopaedic Foot and Ankle Center, Falls Church, VA, USA
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12
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Abstract
Jones fractures in both elite and recreational athletes are best treated with surgical fixation, given superior results as compared to nonoperative management. While screw specifics remain controversial, intramedullary screw fixation is established as the standard surgical technique. Plate fixation also has shown excellent outcomes. Complications of refracture, nonunion, and delayed union require careful evaluation for contributions of early return to play, implant characteristics, and anatomic/metabolic abnormality. Revision fixation with autograft and biologic augmentation is supported in the literature, with ongoing inquiry to optimizing specific implants and adjuvants.
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Affiliation(s)
- David J Ruta
- Bellin Health Titletown Sports Medicine and Orthopedics, 1970 S. Ridge Road, Green Bay, WI 54304, USA.
| | - David Parker
- University of Tennessee-Campbell Clinic Orthopaedics, 1400 S. Germantown Road, Germantown, TN 38138, USA
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Headless compression screw fixation of Jones fractures: a clinical and radiographic comparison study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Watson S, Trammell A, Tanner S, Martin S, Bowman L. Early Return to Play After Intramedullary Screw Fixation of Acute Jones Fractures in Collegiate Athletes: 22-Year Experience. Orthop J Sports Med 2020; 8:2325967120912423. [PMID: 32426399 PMCID: PMC7219008 DOI: 10.1177/2325967120912423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: There is disagreement among team physicians, without conclusive evidence, as to when high-level athletes with a Jones fracture should be allowed to return to play after being treated operatively with an intramedullary screw. Purpose: To report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones fractures. Study Design: Case series; Level of evidence, 4. Methods: We identified all collegiate athletes with an acute fracture at the base of the fifth metatarsal treated by 1 of 2 orthopaedic surgeons with intramedullary screw fixation over a 22-year period (1994-2015), and we performed a retrospective review of their records. Fixation consisted of a single intramedullary screw. Athletes were allowed to bear weight as tolerated in a walking boot immediately postoperatively and return to play as soon as they could tolerate activity. Patients were contacted to complete patient-reported outcome scores that included the Foot and Ankle Ability Measure (FAAM) score, a brief survey specific to our study, and follow-up radiographs. Results: A total of 26 acute Jones fractures were treated in 25 collegiate athletes (mean age, 20 years; range, 18-23 years). Overall, the athletes returned to play at an average of 3.6 weeks (range, 1.5-6 weeks). Three screws were removed for symptomatic skin irritation. There was 1 refracture after screw removal that was done after radiographic and clinical documentation of fracture union, which was treated with repeat cannulated percutaneous screw fixation. One screw was observed on radiographs to be broken at 1 year postoperatively, but the fracture was healed and the athlete was playing National Collegiate Athletic Association Division I sports without symptoms and continued to play professionally without symptoms. Of 25 athletes, 19 completed the FAAM at an average follow-up of 8.6 years (range, 1.5-20.0 years). They reported scores of 94.9% (range, 70.2%-100%) for the activities of daily living subscale and 89.1% (range, 42.9%-100%) for the sports subscale. Follow-up radiographs were obtained, and no nonunion, malunion, or additional hardware complications were identified. Conclusion: Athletes with acute Jones fractures can safely be allowed to return to play after intramedullary screw fixation as soon as their symptoms allow, without significant complications. In our experience, this is usually within 4 weeks from injury.
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Affiliation(s)
- Scott Watson
- Blue Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Health-Upstate, Seneca, South Carolina, USA
| | - Amy Trammell
- Department of Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Stephanie Tanner
- Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Steven Martin
- Blue Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Health-Upstate, Seneca, South Carolina, USA
| | - Larry Bowman
- Blue Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Health-Upstate, Seneca, South Carolina, USA
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15
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Willegger M, Benca E, Hirtler L, Kasparek MF, Bauer G, Zandieh S, Windhager R, Schuh R. Evaluation of Two Types of Intramedullary Jones Fracture Fixation in a Cyclic and Ultimate Load Model. J Orthop Res 2020; 38:911-917. [PMID: 31743452 PMCID: PMC7155054 DOI: 10.1002/jor.24530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/10/2019] [Indexed: 02/04/2023]
Abstract
Implant choice is a matter of concern in athletes and active patients who sustain a Jones fracture because they are prone to failure including non-union, screw failure, and refracture. The aim of this study was to compare the biomechanical behavior of a Jones fracture-specific screw (JFXS) with a cannulated headless compression screw (HCS) in a simulated partial weight-bearing and ultimate load Jones fracture fixation model. Ten matched pairs of human anatomical specimens underwent Jones fracture creation and consecutive intramedullary stabilization with a solid JFXS or a cannulated HCS. The bone mineral density was assessed prior to testing. Cyclic plantar to dorsal loading was applied for 1000 cycles, followed by load to failure testing. Angulation was measured by an opto-electronic motion capture system and mode of failure classification was determined by video analysis. Paired analysis showed no statistically significant difference between both screw constructs. Ultimate load reached 236.9 ± 107.8 N in the JFXS group compared with 210.8 ± 150.7 N in the HCS group (p = 0.429). The bone mineral density correlated positive with the pooled ultimate load (R = 0.580, p = 0.007) for all constructs and negatively with angulation (R = -0.680, p = 0.002) throughout cyclic loading. Solid fracture-specific and cannulated headless compression screws provide equal ultimate loads and stiffness for Jones fracture fixation. A low bone mineral density significantly impairs the construct stability and the ultimate load of both intramedullary screw constructs. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:911-917, 2020.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
| | - Emir Benca
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Division of AnatomyMedical University of ViennaViennaAustria
| | - Maximilian F. Kasparek
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
| | - Gregor Bauer
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
| | - Shahin Zandieh
- Department of Radiology and Nuclear MedicineHanusch HospitalViennaAustria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
| | - Reinhard Schuh
- Department of Orthopedics and Trauma Surgery, Division of OrthopedicsMedical University of ViennaViennaAustria
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16
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Bucknam RB, Scanaliato JP, Kusnezov NA, Heida KA, Dunn JC, Orr JD. Return to Weightbearing and High-Impact Activities Following Jones Fracture Intramedullary Screw Fixation. Foot Ankle Int 2020; 41:379-386. [PMID: 31904264 DOI: 10.1177/1071100719898278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Ryan B Bucknam
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery, Blanchfield Army Community Hospital, Ft. Campbell, KY, USA
| | - Kenneth A Heida
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Justin D Orr
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
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17
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Jones Fractures in Sumo Wrestlers: Three Case Reports. Case Rep Orthop 2019; 2019:9051327. [PMID: 31772802 PMCID: PMC6854976 DOI: 10.1155/2019/9051327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 11/18/2022] Open
Abstract
Jones fractures sometimes occur in athletes and are known to have complications, such as nonunion, delayed union, and recurrence, even with treatment. We describe three cases of Jones fractures in sumo wrestlers with treatment-related difficulties. All patients discontinued treatment at their own discretion. The two conservative cases had nonunion or delayed union, and the operative case had a broken screw. However, all patients continued sumo wrestling, with little impact on their careers. The risk factors of Jones fractures in sumo wrestling may be heavy weight, and training or competition characteristics unique to sumo wrestling. In cases of a complete Jones fracture, operative treatment is most commonly selected, as the risk for nonunion or refractures is less than that for conservative treatment. However, in the case of sumo wrestlers, there are risks of infection and problems with treatment compliance. As taking a rest may result in a lowered rank, completing a sufficient duration of treatment is difficult. Treatment is difficult and controversial in sumo wrestlers; all three patients discontinued treatment of their own accord. These cases suggest that it is important to thoroughly inform sumo wrestlers of the treatment options, and to decide the most appropriate treatment method for each patient.
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18
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Anderson R, Parekh S, Braid-Forbes MJ, Steen RG. Delayed Healing in Metatarsal Fractures: Role of Low-Intensity Pulsed Ultrasound Treatment. J Foot Ankle Surg 2019; 58:1145-1151. [PMID: 31548075 DOI: 10.1053/j.jfas.2019.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/11/2019] [Accepted: 03/25/2019] [Indexed: 02/03/2023]
Abstract
The most common fracture in primary care is metatarsal fracture, but it is controversial whether to treat this fracture conservatively or surgically. We performed a cohort study to contrast metatarsal fractures that heal normally with fractures that show delayed healing. We analyzed 5% Medicare Standard Analytic Files, selecting all metatarsal fractures in 2011 to 2013, excluding patients with multiple fractures. Delayed healing was defined as treatment >14 days postfracture with either low-intensity pulsed ultrasound or surgery. Treatment for delayed healing was identified using the Current Procedural Terminology and International Classification of Diseases, Revision 9, Clinical Modification codes. Among 9482 metatarsal fractures, 256 (2.7%) showed delayed healing. Patients with delayed healing were younger (p < .0001); more likely to receive specialist referral (p < .001); more likely to have obesity (p = .005), psychosis (p = .003), chronic lung disease (p = .012), or iron deficiency anemia (p = .016); and more likely to receive surgery before ultrasound (p < .0001). Patients more likely to be treated with surgery than ultrasound included younger patients (p < .0001), obese patients (p = .02), and patients who first see a specialist (p < .05).
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Affiliation(s)
| | - Selene Parekh
- Professor of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University, Durham, NC
| | | | - R Grant Steen
- Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Louisiana State University Health Science Center, New Orleans, LA.
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19
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Miller D, Marsland D, Jones M, Calder J. Early return to playing professional football following fixation of 5th metatarsal stress fractures may lead to delayed union but does not increase the risk of long-term non-union. Knee Surg Sports Traumatol Arthrosc 2019; 27:2796-2801. [PMID: 30167755 DOI: 10.1007/s00167-018-5104-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE 5th metatarsal stress fractures are frequently encountered in professional football. There is concern that early return to play following intra-medullary screw fixation may lead to an increased risk of delayed union. The purpose of the study was to assess whether an early return to play after surgical fixation of 5th metatarsal fractures in professional football players is a risk factor for delayed union and the effect of this on the ultimate clinical outcome. METHODS Retrospective review of prospectively collected data of a series of 37 professional football players following intramedullary screw fixation of 5th metatarsal stress fractures. End points included time of return to play and to radiological union of the fracture. RESULTS At a minimum follow-up of 24 months the mean return to play was 10.5 weeks and mean time to complete radiological union was 12.7 weeks. Return to play at 8 weeks or less resulted in a higher risk of delayed radiological union (24% at 3 months), but this neither prevented the athlete from continuing to play football nor did it affect the ultimate risk of non-union (3% overall). A re-fracture occurred in 1 patient (3%) at 10 months who previously had complete radiographic union at 9 weeks. CONCLUSION Intramedullary screw fixation of 5th metatarsal stress fractures leads to a predictable time of return to play and a low rate of non-union. If players return to play at 8 weeks or less a persistent line may be expected in up to a quarter of patients. However, if asymptomatic this radiological finding does not mean that athletes must avoid playing football as ultimately a good outcome is expected with low rates of non-union and refracture. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- David Miller
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
| | - Daniel Marsland
- Royal Hampshire County Hospital, Romsey Rd, Winchester, SO22 5DG, UK
| | - Mary Jones
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK
| | - James Calder
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.,FORCE Sports Research Centre, Department of Bioengineering, Imperial College, South Kensington, London, SW7 2AZ, UK
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20
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Roberts L, Bernasconi A, Netto CDC, Elliott A, Hamilton W, O'Malley M. Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes. Foot Ankle Spec 2019; 12:373-379. [PMID: 31248285 DOI: 10.1177/1938640019857798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stress fractures of the proximal fifth metatarsal are common injuries in elite athletes. Fixation using an intramedullary screw represents the most popular surgery performed for treating these injuries, with excellent results in most cases. However, multiple reports in the literature highlight the possibility of painful hardware, usually related to the presence of the screw head, following intramedullary fixation In this case report, we outline 4 cases of professional athletes who developed lateral-based foot symptoms following complete healing of their surgically treated proximal fifth metatarsal fractures and were found to have significant cuboid edema on magnetic resonance images. We also outline recommendations regarding specific surgical technique considerations aiming to minimize this possible complication. Level of Evidence: Level V: Case report.
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Affiliation(s)
- Lauren Roberts
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, Stanmore, Middlesex, UK
- Orthopaedics and Traumatology Unit, Department of Public Health, "Federico II" University of Naples, Napoli, Italy
| | - Cesar de Cesar Netto
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Andrew Elliott
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - William Hamilton
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Martin O'Malley
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
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21
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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22
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Spang RC, Haber DB, Beaulieu-Jones BR, Stupay KL, Sanchez G, Sanchez A, Murphy CP, Whalen JM, Van Allen JJ, Price MD, Clanton TO, Provencher MT. Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance. Orthop J Sports Med 2018; 6:2325967118790740. [PMID: 30182027 PMCID: PMC6113739 DOI: 10.1177/2325967118790740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls (P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.
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Affiliation(s)
- Robert C Spang
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - George Sanchez
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Colin P Murphy
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Mark D Price
- Massachusetts General Hospital, Boston, Massachusetts, USA.,New England Patriots, Foxborough, Massachusetts, USA
| | - Thomas O Clanton
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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23
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Baumbach SF, Prall WC, Kramer M, Braunstein M, Böcker W, Polzer H. Functional treatment for fractures to the base of the 5th metatarsal - influence of fracture location and fracture characteristics. BMC Musculoskelet Disord 2017; 18:534. [PMID: 29246170 PMCID: PMC5732483 DOI: 10.1186/s12891-017-1893-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/04/2017] [Indexed: 01/29/2023] Open
Abstract
Background Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome. Methods Retrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the fifth metatarsal bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics (displacement <2 mm or >2 mm, intra-articular involvement, and number of fragments) were assessed. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. The influence of the fracture (1) location and (2) -characteristics on these parameters was tested. Results Thirty-nine patients (40 ± 15 years, 56% female) were enrolled with a mean follow-up of 22 ± 10 months. L&B type I fractures occurred in 59%, type II in 41%. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. Patients returned to work after 17 ± 12 days, to sports after 53 ± 22 days. The VAS-FA score at the final follow-up was 96 ± 4, SF-12 PCS score 57 ± 5 and MCS score 51 ± 8. No complications were reported, no patient required surgery. None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments). Conclusions (1) Both, L&B I and II fractures featured excellent results with immediate full weightbearing. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. (2) Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures.
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Affiliation(s)
- Sebastian Felix Baumbach
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolf Christian Prall
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
| | - Michael Kramer
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
| | - Mareen Braunstein
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
| | - Hans Polzer
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany.
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24
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Varner KE, Harris JD. The Proximal Fifth Metatarsal Metadiaphyseal Jones Fracture: Intramedullary Screw vs Plantar Plate. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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