Intramedullary Screw Fixation Supplemented by Scapular Spine Plating: A Surgical Technique for the Base of Acromion Fracture

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.

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Early Return To Play After Intramedullary Screw Fixation Of Jones Fractures In Collegiate Athletes: 23 Year Experience

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00121 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0012

Author(s):

Scott Thomas Watson ◽

Amy Trammell ◽

Stephanie Tanner ◽

Rebecca Snider ◽

Steven Martin ◽

...

Keyword(s):

Screw Fixation ◽

Collegiate Athletes ◽

Patient Reported Outcome ◽

Return To Play ◽

Early Return ◽

Hardware Complications ◽

Patient Reported ◽

Outcome Scores ◽

Intramedullary Screw

Objectives: There is a general consensus that Jones fractures should be treated operatively with an intramedullary screw in high-level athletes. However, there is disagreement among team physicians, without conclusive evidence as to when the athlete should be allowed to return to play. The objective of this study is to report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones Fractures. Methods: All skeletally mature collegiate athletes with a true Jones fracture of the base of the fifth metatarsal that was treated by one of two orthopaedic surgeons with operative intramedullary screw fixation over a 23 year period (1994-2016) were identified and records reviewed retrospectively. All return to play and complication data was obtained from the athletic trainer database at the two universities. Fixation consisted of a single intramedullary screw (10 partially threaded cannulated screws, 13 cannulated variable pitch screws, 3 solid screws). The athletes were allowed to weight bear as tolerated in a CAM boot immediately postoperatively, and return to play with a carbon fiber insert as soon as they could tolerate activity. In 2016, patients were contacted to complete patient reported outcome scores that included the Foot and Ankle Ability Measure (FAAM) score and a brief survey specific to our study, as well as follow-up radiographs if possible. Results: 26 Jones Fractures were treated in 25 collegiate athletes. The average age was 20 years (18-23). Overall, athletes returned to play or training at an average of 3.5 weeks (1.5-6). All in-season athletes returned to play within 4.5 weeks (1.5-4.5). Off-season athletes returned to play within 4-6 weeks. There were no cases of nonunion (clinically or radiographically). Three screws were removed due to symptomatic skin irritation. There was one re-fracture following screw removal after documented radiographic and clinical fracture union. This patient was treated with repeat cannulated percutaneous screw fixation. The athlete returned to play in 2 weeks. One screw was noted to be broken on an ankle radiograph 1 year post-op, but the fracture was healed and the athlete was playing division 1 sports without symptoms, and continued professionally without symptoms. 18/25 athletes completed patient reported outcome scores at an average of 7.95 years (range 1.2-17) follow-up. The average estimated percent of normal for activities of daily living was 93.8% (70-100%, and for athletic participation was 90.3% (40-100%). Follow up radiographs were obtained on 13/26 fractures at an average of 6.48 years (range 1.2-16) with no nonunion, malunion, or additional hardware complications identified. Conclusion: Athletes with 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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Intramedullary screw fixation of metacarpal and phalangeal fracture – A systematic review of 837 patients

Hand Surgery and Rehabilitation ◽

10.1016/j.hansur.2021.04.009 ◽

2021 ◽

Author(s):

U. Hug ◽

F. Fiumedinisi ◽

A. Pallaver ◽

B.J.M. van de Wall ◽

F.J.P. Beeres ◽

...

Keyword(s):

Systematic Review ◽

Screw Fixation ◽

Intramedullary Screw ◽

Phalangeal Fracture

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Strength of Humeral and Ulnar Intramedullary Screw Fixation

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2021.07.037 ◽

2021 ◽

Author(s):

Sameer Shetty ◽

Brody Nelson ◽

Brian Knopp ◽

Johannes Schneppendahl ◽

Robert A. Kaufmann

Keyword(s):

Screw Fixation ◽

Intramedullary Screw

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Screw Length Associated with Fracture Gapping of Fifth Metatarsal Base Fracture with Intramedullary Screw Fixation: A Cadaveric Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2021.12.025 ◽

2021 ◽

Author(s):

Nicole K. Cates ◽

Amar R. Gulati ◽

Jonathan D. Tenley ◽

Nathan N. O'Hara ◽

Jacob Wynes ◽

...

Keyword(s):

Screw Fixation ◽

Cadaveric Study ◽

Screw Length ◽

Intramedullary Screw

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Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

Hand ◽

10.1177/1558944720928503 ◽

2020 ◽

pp. 155894472092850

Author(s):

Brahman S. Sivakumar ◽

Vincent V. G. An ◽

David J. Graham ◽

James Ledgard ◽

Richard D. Lawson ◽

...

Keyword(s):

English Language ◽

Screw Fixation ◽

Adhesion Formation ◽

Major Complication ◽

Original Data ◽

Active Motion ◽

Early Motion ◽

Total Active Motion ◽

Phalangeal Fractures ◽

Intramedullary Screw

Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.

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