Nonoperative Treatment of Stress Fractures of the Proximal Shaft of the Fifth Metatarsal (Jones' Fracture)

Foot & Ankle ◽  
1986 ◽  
Vol 7 (3) ◽  
pp. 152-155 ◽  
Author(s):  
James H. Acker ◽  
David Drez
Keyword(s):  
Case Reports ◽  
Athletic Participation ◽  
Delayed Union ◽  
Nonoperative Treatment ◽  
Stress Fractures ◽  
High Potential ◽  
Jones Fracture ◽  
Operative Fixation

Early operative fixation of stress fractures of the proximal diaphysis of the fifth metatarsal has been advocated because of the high potential for delayed union, nonunion, and refracture. Case reports are given of three athletes with stress fractures of the proximal shaft of the fifth metatarsal who were treated nonoperatively and who returned to early athletic participation without recurrent symptoms or refracture. Treatment of this injury should be individualized because of the potential for nonunion and the ability of this fracture to heal.

scholarly journals Early Weightbearing after Operative Fixation of Jones Fractures Does Not Delay Union

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0033
Author(s):  
Austin Looney ◽  
Daniel M. Dean ◽  
John Renehan ◽  
Thomas H. Sanders ◽  
Daniel J. Cuttica ◽  
...  
Keyword(s):  
Delayed Union ◽  
Healing Time ◽  
Bivariate Analysis ◽  
Published Data ◽  
Vte Prophylaxis ◽  
Jones Fracture ◽  
Surgical Fixation ◽  
Operative Fixation ◽  
The Relationship ◽  
Mean Time

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Jones fracture of the proximal fifth metatarsal metadiaphysis is predisposed to delayed union and nonunion due to a tenuous blood supply. Surgical fixation followed by delayed weightbearing is commonly recommended, though the optimal period of nonweightbearing after surgery is not well defined. In response to more recent literature and in an effort to facilitate functional recovery, the trend in our practice has begun to shift toward earlier weightbearing for all patients after Jones fracture fixation. The purpose of this study is to investigate the effect of earlier weightbearing after surgical fixation of Jones fractures. Methods: All Jones fractures treated with an intramedullary (IM) screw in a large, urban practice from 2012-2018 were identified. We excluded fractures that were chronic in nature and patients with underlying metabolic disease. We defined a delayed union as longer than 12.5 weeks based on published data. Time to weightbearing and early weightbearing (within 1 week of surgery) were investigated as risk factors for delayed union using logistic regression and Fisher exact tests, respectively. The relationship between time to weightbearing and time to union was assessed with Spearman correlation. Additional variables were explored in bivariate analysis: time to surgery from initial presentation; age, sex, chronicity, tobacco use, weight, BMI, screw size; preoperative NSAID use, and postoperative VTE prophylaxis. Multivariate regression analyses were then performed to identify variables independently predictive of delayed union. Results: Forty-one cases were included (17 males, 24 females), all treated with IM fixation. Median age in the sample was 45 years ( IQR, 32-62 years). Overall mean time to union was 10.9 +- 7.0 weeks (range, 4.9-41.4 weeks). There were nine (22.0%) delayed unions. Earlier weightbearing was not significantly predictive of delayed union (OR 1.02; 95% CI, 0.99-1.05; P = 0.211), and the incidence of nonunion was not significantly different between early and delayed weightbearing groups (OR, 1.20; 95% CI, 0.02- 17.54; P > .999). In bivariate analysis, increasing age was associated with increasing risk of delayed union (OR, 1.06; 95% CI, 1.01- 1.12; P = 0.031), and was correlated with time to union (ρ = 0.327, P = 0.037). Mutivariate analaysis demonstarted no significant variables. Conclusion: Our results suggest that earlier weightbearing after internal fixation of Jones fractures is not a risk factor for delayed union and does not significantly alter healing time. These findings are consistent with previously published data, but go further by assessing the effects of time to weightbearing in continuous regression models.

scholarly journals Bilateral Proximal Tibia Stress Fractures through Persistent Physes

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
John J. Carroll ◽  
Sean P. Kelly ◽  
James N. Foster ◽  
Derek A. Mathis ◽  
Joseph F. Alderete
Keyword(s):  
Tibial Plateau ◽  
Proximal Tibia ◽  
Hyaline Cartilage ◽  
Articular Surface ◽  
Case Reports ◽  
Stress Fractures ◽  
Laboratory Evaluation ◽  
Distal Fibula ◽  
Operative Fixation ◽  
Repetitive Trauma

Introduction. Fatigue fractures are stress fractures resulting from repetitive trauma in areas of stress concentration. Prior case reports and studies have described stress fractures through persistent physes about the olecranon and distal fibula, as evidenced by hyaline cartilage on histologic analysis. However, there have been no documented proximal tibia stress fractures through persistent physes. Case Presentation. A 29-year-old military male basic trainee with varus alignment about his knees suffered bilateral medial tibial plateau stress fractures several weeks into military basic training. He underwent radiographic and laboratory evaluation of his stress fractures and eventual operative fixation of his bilateral tibial plateau fractures. Intraoperative specimens obtained from the fracture sites distal to the articular surface demonstrated abnormal fibrous appearing tissue. Histology demonstrated the presence of hyaline cartilage. Discussion. A 29-year-old military male basic trainee had bilateral proximal tibia stress fractures through persistent physes confirmed with biopsies demonstrating hyaline cartilage. Our belief is that the patient’s persistent physes placed him at a greater risk for stress fractures and these may benefit from fixation in soldiers and athletes.

scholarly journals Tibial Stress Fracture After Ankle Arthrodesis: Case Series with Different Treatment Modalities

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0008
Author(s):  
Mohamed E. Abdelaziz ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Seth O’Donnell ◽  
Brad Blankenhorn ◽  
...  
Keyword(s):  
Stress Fracture ◽  
Case Reports ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Nonoperative Treatment ◽  
Stress Fractures ◽  
Treatment Modalities ◽  
Ankle Arthritis ◽  
Fibular Osteotomy ◽  
Tibial Stress Fracture

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: End-stage ankle arthritis is frequently treated with tibiotalar or tibio-talar-calcaneal (TTC) arthrodesis, whose sequelae include adjacent joint arthritis presumptively due to the increased stress inherent to the loss of a motion segment. The loss of ankle motion may also stress the distal tibia, and individual case reports exist describing tibial stress fracture after ankle arthrodesis. These case reports do not describe operative treatment however. The purpose of this study is to report a case series of patients who presented with a stress fracture of the tibia after ankle arthrodesis, a subsegment of whom failed nonoperative management, highlighting related risk factors and treatment strategies. Methods: The medical records at two large academic medical centers were reviewed retrospectively, from 1990 to 2017 at the first center and from 2013 to 2017 at the second center, to identify patients who had undergone ankle arthrodesis. Any patient who subsequently developed a stress fracture of the tibia, confirmed clinically and/or radiographically, was included in the subsequent analysis. Patients with a history of stress fracture prior to arthrodesis or with non-tibia stress fractures were excluded. Patient demographics were collected alongside surgical technique, duration of postoperative non-weight bearing status, presence of medical co-morbidities including osteoporosis and tobacco use, location of tibial stress fracture, and treatment strategy. Results: Twelve patients out of 988 (1.2%) developed tibial stress fracture. Seven patients underwent isolated ankle arthrodesis, four underwent ankle arthrodesis subsequent to subtalar fusion with a resultant ankle nonunion in two requiring revision TTC nailing, and one underwent primary TTC arthrodesis. Four patients had fibular osteotomy, and four had the lateral malleolus resected. The stress fracture was at the level of fibular osteotomy in two patients, and at the proximal end of existing or removed implant in six patients. All patients were treated initially with immobilization and activity modification except for one who had fracture displacement and underwent immediate plate fixation, and three who failed to improve with nonoperative treatment required fixation (two intramedullary nails, one plate). Conclusion: Tibial stress fractures can occur after an isolated ankle arthrodesis but is likely potentiated in the setting of previously or concomitantly fused subtalar joint. Transition points are especially at risk, either at the proximal end of an implant or at the proximal extent of a fibular osteotomy. Critically, stress fractures may present many years after ankle arthrodesis, with an average of four years in this series. In our series one third of patients necessitated surgical management, underscoring the importance of accurate diagnosis. Ultimately patients appear to do well with surgical repair even if they fail initial nonoperative treatment.

Proximal Diaphyseal Fractures of the Fifth Metatarsal (Jones' Fracture): Two Cases Treated by Cross-Pinning with Review of 106 Cases

Foot & Ankle ◽  
1983 ◽  
Vol 3 (5) ◽  
pp. 293-296 ◽  
Author(s):  
George A. Arangio
Keyword(s):  
Delayed Union ◽  
Jones Fracture ◽  
Diaphyseal Fractures

Two cases of successful percutaneous cross-pinning of one acute and one delayed union of Jones' fracture are presented. One hundred six cases of Jones' fracture, taken from the literature, are reviewed and tabulated.

Length of Nonoperative Treatment and Risk of Pleural Empyema in the Management of Pancreatitis-induced Pancreaticopleural Fistula

2013 ◽  
Vol 79 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Michael Schweigert ◽  
Norbert Solymosi ◽  
Attila Dubecz ◽  
Dietmar Ofner ◽  
Hubert J. Stein
Keyword(s):  
Surgical Intervention ◽  
Nonoperative Management ◽  
Case Reports ◽  
English Literature ◽  
Fistulous Tract ◽  
Pleural Empyema ◽  
Nonoperative Treatment ◽  
Endoscopic Stenting ◽  
Septic Complications ◽  
Ascending Infection

Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Initial conservative treatment fails in a significant number of cases. Ascending infection through the fistulous tract results in pleural empyema. The aim of this study is to investigate the relation between lengths of nonoperative management and risk of pleural empyema. The retrospective study includes our own experience as well as all case reports identified by a systematic review of the English literature from 1954 to 2012. Inclusion criteria were acute or chronic pancreatitis, whereas tumorous fistulization or complications of pancreatic surgery were kept out. A total of 113 patients were identified. There were 86 men and 27 women. The mean age was 46.5 years and 78 patients had a history of alcoholism. The mortality rate was 1.8 per cent (two of 113). Non-operative management including interventional therapy and endoscopic stenting was successful in only 40 cases (36%), whereas 73 patients (64%) finally underwent surgery. The most common procedure was distal pancreatectomy (32 of 73). Pleural empyema occurred in 17 cases. Successful nonoperative management had a mean length of 5.5 weeks, whereas surgery was performed after an average of 10.9 weeks of failed conservative efforts. Initial nonoperative therapy was significantly longer in patients eventually sustaining empyema (17 weeks, P < 0.001) and all needed surgical intervention. Prolonged nonoperative treatment is associated with a noteworthy risk of septic complications such as pleural empyema. Further improvement seems achievable by reducing the time gap between fruitless conservative efforts and surgical intervention.

scholarly journals Postoperative Aspirin Use and Its Effect on Bone Healing in the Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Allison Hunter ◽  
Charles Pitts ◽  
Tyler Montgomery ◽  
Matthew Anderson ◽  
John T. Wilson ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Delayed Union ◽  
Ankle Fractures ◽  
P Value ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Ankle Trauma ◽  
Operative Fixation ◽  
Deep Vein ◽  
Radiographic Union

Category: Ankle, Trauma Introduction/Purpose: There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. We examine the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. We hypothesize that time to clinical and radiographic union and the risk of DVT are no different. Methods: A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution with a minimum of 3 months follow up. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph. Results: 506 patients met inclusion criteria: 152 received ASA and 354 did not. Radiographic healing at 6 weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305). Conclusion: Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.

scholarly journals Nonoperative Treatment of Ulnar Carpometacarpal Fracture–Dislocations

2019 ◽  
Vol 09 (02) ◽  
pp. 160-163
Author(s):  
Isidro Jiménez ◽  
Juan Sánchez-Hernández ◽  
Dimosthenis Kiimetoglou
Keyword(s):  
Closed Reduction ◽  
Case Reports ◽  
Nonoperative Treatment ◽  
Fracture Dislocation ◽  
Joint Stability ◽  
Joint Dislocations ◽  
Secondary Dislocation ◽  
Fracture Dislocations ◽  
Cmc Joint

Abstract Background Ulnar carpometacarpal (CMC) joint dislocations and fracture–dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description This is a series of eight ulnar CMC joint dislocations and fracture–dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

ULTRASONOGRAPHY AS A DIAGNOSTIC MODALITY OF TIBIAL STRESS FRACTURES

2008 ◽  
Vol 11 (02) ◽  
pp. 55-61 ◽  
Author(s):  
Uri Farkash ◽  
Javier Naftal ◽  
Estela Deranze ◽  
Alexander Blankstein
Keyword(s):  
Bone Scan ◽  
Imaging Modality ◽  
Case Reports ◽  
Stress Fractures ◽  
Surface Irregularity ◽  
Double Blind Study ◽  
Basic Training ◽  
Double Blind ◽  
Diagnostic Modality ◽  
Medicine Service

Tibial stress fractures (SFs) are a common orthopedic problem during military basic training. Bone scan is considered the gold standard for diagnosing this condition. Several case reports have described sonographic features of stress fractures. This is a prospective, double-blind study to compare diagnostic ultrasound (US) examination with isotope bone scan in diagnosing SF. Thirty-one soldiers who were referred to the nuclear medicine service for a bone scan to rule out tibial SF participated in this study. The SF lesions of the lower extremities were classified according to the classification criteria introduced by Zwas et al.20 US examination was performed on the same day. Areas of cortical thickening and other pathologies like bone surface irregularity and bone discontinuity were recorded. Each examination was graded as either normal or suggestive of representing a SF. Thirty of 62 tibiae were diagnosed as having SF according to bone scan, whereas US examination suggested SF in 35 tibiae. US examination was positive in 20 of 30 tibiae with SF (67% sensitivity, 53% specificity). Although US correctly diagnosed SF in 20 tibiae, bone scan remains the chosen imaging modality to detect SF in soldiers. US was not found to be a reliable modality to diagnose SF.

Sign in / Sign up

Export Citation Format

Share Document