scholarly journals Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Stress Fracture in an Elite Athlete: A Case Report

2017 ◽  
Vol 03 (01) ◽  
pp. e6-e8
Author(s):  
Steffen Sauer
Keyword(s):  
Elite Athlete ◽  
Screw Fixation ◽  
Elite Athletes ◽  
Weight Bearing ◽  
Basketball Player ◽  
Competitive Sport ◽  
Varus Alignment ◽  
Pes Cavus ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

AbstractIntramedullary screw fixation of proximal fifth metatarsal fractures is a simple surgical procedure, enabling early postoperative weight-bearing and subsequently rapid return to competitive sport, which is of great significance for elite athletes. The procedure is described in an elite basketball player in this article. Pes cavus and hindfoot varus alignment potentiate cyclic loading onto the fifth metatarsal and should be addressed as it may represent underestimated factors concerning fracture prognosis.

scholarly journals Patient Reported Outcomes in Athletes following ORIF of Jones Fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Monique Chambers ◽  
MaCalus Hogan ◽  
Dukens LaBaze ◽  
Ermias Abebe ◽  
Joseph Kromka
Keyword(s):  
Patient Reported Outcomes ◽  
Elite Athlete ◽  
Screw Fixation ◽  
Elite Athletes ◽  
Visual Analog Score ◽  
Return To Play ◽  
Secondary Fracture ◽  
Jones Fracture ◽  
Patient Reported ◽  
Intramedullary Screw

Category: Lesser Toes, Midfoot/Forefoot, Sports Introduction/Purpose: Treatment of fractures to the 5th metatarsal metaphyseal-diaphyseal junction, known as Jones’ fractures, can present challenges in the elite athlete significantly prolonging return to play. Non-operative treatments in elite athletes result in a high incidence of nonunion and secondary fracture. Primary screw fixation remains the standard of care for athletes. However, delayed union and nonunion are still very common despite surgical fixation due to the fracture occurring in a watershed area with decreased healing potential. Bone marrow aspirate concentrate (BMAC) is an autologous source of hematopoeitic and mesenchymal stem cells that has been used in the treatment of poor healing fractures. We hypothesize that open reduction internal fixation (ORIF) augmented with BMAC will improve patient-reported outcome measures following Jones’ fractures in athletes. Methods: This study was a retrospective review of elite athletes that underwent intramedullary screw fixation augmented with BMAC for Jones’ fractures at an academic medical institution. All patients were assessed preoperatively and postoperatively to determine their pain outcomes based on their visual analog score (VAS). Student’s t test was used in statistical comparison of the preoperative and postoperative outcome scores. P < 0.05 was considered significant. Results: A total of 16 elite athletes were treated with ORIF with BMAC for a Jones fracture with a mean age of 22.2 years (range 19–26). There were 9 males and 7 females included in the study. Type of athlete ranged across various sport activities, with all patients functioning at a collegiate and/or professional level of elite athletics. The mean visual analog score for pain decreased from 6.2 preoperatively (range 3-8) to 2.75 postoperatively (range 1-6 p = 0.06). All patients have returned to elite competitive sport activity with reports of minimal to no pain. Conclusion: Intramedullary screw fixation of Jones’ fractures with BMAC results in optimal surgical outcomes in the elite athlete. A higher powered and long-term study with validated patient-reported outcomes is needed to confirm our observations.

scholarly journals Jones Fracture in the Elite Athlete: Patient Reported Outcomes following Fixation with BMAC

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016 ◽  
Author(s):  
Dwayne Carney ◽  
Monique C. Chambers ◽  
Joseph James Kromka ◽  
Dukens LaBaze ◽  
Robin Vereeke West ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Elite Athlete ◽  
Screw Fixation ◽  
Elite Athletes ◽  
Return To Play ◽  
Jones Fracture ◽  
Long Term Study ◽  
Patient Reported ◽  
Intramedullary Screw

Objectives: Jones’ fractures, 5th metatarsal metaphyseal-diaphyseal junction fractures, are a debilitating injury for the elite athlete, particularly in cutting/pivoting sports. These injuries are usually managed surgically due to the high rate of nonunion and re-fracture. Despite primary screw fixation, delayed union and nonunion are not uncommon. Bone marrow aspirate concentrate (BMAC), an autologous source of hematopoietic and mesenchymal stem cells, has been used to augment healing due to the poor healing potential in the watershed region. We hypothesize that open reduction internal fixation (ORIF) augmented with BMAC will improve patient-reported outcome measures following Jones’ fractures in athletes. Methods: This study was a prospectively collected and maintained review of elite athletes that underwent intramedullary screw fixation augmented with BMAC for Jones’ fractures at an academic medical institution. All patients were evaluated preoperatively and postoperatively to assess differences in patient reported outcomes including VAS, PROMIS, FAAM, SF-12 scores, return to play, and complications. Student’s t test was used in statistical comparison of the preoperative and postoperative outcome scores. P < 0.05 was considered significant. Results: A total of 41 elite athletes were treated with ORIF with BMAC for a Jones fracture with a mean age of 25.59 years (range 19-42). There were 26 (63%) males and 15 females included in the study. Type of athlete ranged across the following sport activities: football, basketball, soccer, volleyball. Of note, patients had significantly improved with lower visual analog score for pain (mean Δ3.56, p= 0.001), higher FAAM scores (mean Δ 43.6, p< 0.001), and PASS scores (increased from 11% to 85%, p< 0.001) at 6 months. Additionally, patients showed improvement in SF12, PROMIS10, and FAAM scores at 12 months, although this was not statistically significant due to insufficient follow up at this time. The average numbers of days lost to competition was 131 days. All patients that have returned to elite competitive sport activity report minimal to no pain. Conclusion: Intramedullary screw fixation of Jones’ fractures with BMAC results in optimal surgical outcomes in the elite athlete. The use of patient reported outcomes continues to be a focus of quality measures and should guide clinical decision making for surgical intervention, return to play, and to assess impact of treatment. A higher powered and long-term study with validated patient-reported outcomes is needed to confirm our observations.

Fifth Metatarsal Jones Fractures in the Athlete

2017 ◽  
Vol 39 (2) ◽  
pp. 250-258 ◽  
Author(s):  
David A. Porter
Keyword(s):  
Screw Fixation ◽  
Nonoperative Treatment ◽  
Fracture Site ◽  
Medullary Canal ◽  
Return To Sports ◽  
Stress Reactions ◽  
Current Standard ◽  
Level Of Evidence ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

Fifth metatarsal fractures, otherwise known as “Jones” fractures, occur commonly in athletes and nonathletes alike. While recent occurrence in the popular elite athlete has increased public knowledge and interest in the fracture, this injury is common at all levels of sport. This review will focus on all three types of Jones fractures. The current standard for treatment is operative intervention with intramedullary screw fixation. Athletes typically report an acute episode of lateral foot pain, described as an ache. Radiographic imaging with multiple views of the weightbearing injured foot are needed to confirm diagnosis. If these images are inconclusive, further magnetic resonance imaging (MRI) or computed tomography (CT) is used. Nonoperative treatment is not commonly used as the sole treatment, except when following reinjury of a stable screw fixation. While screw selection is still controversial, operative treatment with intramedullary screw fixation is the standard approach. Technical tips on screw displacement are provided for Torg (types I, II, III) fractures, cavovarus foot fractures, recurrent fractures, revision surgery, occult fractures/high-grade stress reactions, and Jones’ variants. Excellent clinical outcomes can be expected in 80% to 100% of patients when using the intramedullary screw fixation to “fit and fill” the medullary canal with threads across the fracture site. Most studies show the timing for return to sports with optimal healing to be seven to twelve weeks after fixation. Level of Evidence: Level V, expert opinion.

Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes

2019 ◽  
Vol 12 (4) ◽  
pp. 373-379 ◽  
Author(s):  
Lauren Roberts ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
Andrew Elliott ◽  
William Hamilton ◽  
...  
Keyword(s):  
Case Report ◽  
Elite Athletes ◽  
Magnetic Resonance Images ◽  
Complete Healing ◽  
Professional Athletes ◽  
Screw Head ◽  
Level Of Evidence ◽  
Metatarsal Fractures ◽  
Literature Highlight ◽  
Intramedullary Screw

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.

Risk of Sural Nerve Injury with Intramedullary Screw Fixation of Fifth Metatarsal Fractures: A Cadaver Study

1999 ◽  
Vol 20 (3) ◽  
pp. 182-184 ◽  
Author(s):  
Brian G. Donley ◽  
Michael J. McCollum ◽  
G. Andrew Murphy ◽  
E. Greer Richardson
Keyword(s):  
Nerve Injury ◽  
Sural Nerve ◽  
Screw Fixation ◽  
Cadaver Study ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

Intramedullary Screw Fixation of Proximal Fifth Metatarsal Fractures: A Biomechanical Study

2001 ◽  
Vol 22 (7) ◽  
pp. 581-584 ◽  
Author(s):  
Steven N. Shah ◽  
Guenther O. Knoblich ◽  
Derek P. Lindsey ◽  
Jennifer Kreshak ◽  
Scott A. Yerby ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Biomechanical Study ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

scholarly journals Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

2008 ◽  
Vol 128 (12) ◽  
pp. 1425-1430 ◽  
Author(s):  
André Leumann ◽  
Geert Pagenstert ◽  
Peter Fuhr ◽  
Beat Hintermann ◽  
Victor Valderrabano
Keyword(s):  
Screw Fixation ◽  
Biomechanical Analysis ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

scholarly journals Headless Compression Screw Fixation of Jones Fractures

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0001
Author(s):  
David Ruta ◽  
Robert Ellis ◽  
Benjamin Grear ◽  
Susan Ishikawa ◽  
David Richardson ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Delayed Union ◽  
Compression Screw ◽  
Chi Square ◽  
Headless Compression Screw ◽  
Clinical Series ◽  
Headless Compression Screws ◽  
Intramedullary Screw ◽  
Radiographic Union

Category: Sports Introduction/Purpose: There remains controversy over the ideal implant for intramedullary screw fixation of fifth metatarsal Jones fractures. Promising results have separately been reported for both indication-specific partially threaded screws and headless compression screws. The purpose of this study was to compare clinical and radiographic results between Jones fracture patients treated with indication-specific partially threaded screws to variable-pitched headless compression screws. We also evaluated the association of various patient and fracture characteristics with surgical failure. Methods: We performed a retrospective review and comparative analyses of all Jones fractures treated with primary intramedullary screw fixation by 4 foot and ankle fellowship-trained orthopaedic surgeons at a single institution from 1995 through 2015. Exclusion criteria included concomitant foot or ankle procedures and revision surgery. Charts were reviewed for patient and injury characteristics, implant, and postoperative course. Serial radiographs were examined for fracture classification (Torg and anatomic zone) and radiographic union. Primary endpoint was number of surgical failures, defined as delayed union, nonunion, or refracture. Secondary endpoints included time to each of radiographic union, weight bearing, and pain resolution. Data were analyzed using independent T test, one-way ANOVA, chi-square, and correlation analyses with significance defined as p < 0.05. Results: Fifty-nine feet were reviewed with mean age 30 years and follow-up 9.6 months. Forty-seven received a partially threaded screw (PT) and 12 feet a headless compression screw (HC). The PT group had more failures (10/47, 21.3% vs. 1/12, 8.3%; p=0.31) and more weeks to full weight (4.2 vs. 3.3, p=0.06), without significant differences in time to radiographic union or pain resolution. Most failures were delayed unions. Pooled union rate was 96.6%. Correlated with failure were age (r=0.469, p < 0.001), diabetes (r=0.390, p=0.002), and BMI (r=0.281, p=0.03), without significant correlation for tobacco, gender, or weight. Compared to Torg 1 and 2, Torg 3 fractures had greater time to pain resolution and radiographic union, age, weight, and BMI. No differences were found between zone II and III fractures. Conclusion: To our knowledge, this is the first reported clinical comparison between indication-specific partially threaded screws (PT) and headless compression screws (HC) for treating Jones fractures. This is also one of the largest clinical series on the subject. The two groups had similar clinical and radiographic results, both with high union rates. While most failures were delayed unions that ultimately healed, the 21% failure rate in the PT group is concerning and may warrant further investigation. Increasing patient age, diabetes, and BMI were associated with worse outcomes. These data support headless compression screw fixation as a viable treatment for Jones fractures.

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