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.

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

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.

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 Early Return to Play After Intramedullary Screw Fixation of Acute Jones Fractures in Collegiate Athletes: 22-Year Experience

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091242 ◽  
Author(s):  
Scott Watson ◽  
Amy Trammell ◽  
Stephanie Tanner ◽  
Steven Martin ◽  
Larry Bowman
Keyword(s):  
Screw Fixation ◽  
Skin Irritation ◽  
Case Series ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Early Return ◽  
Hardware Complications ◽  
Patient Reported ◽  
Intramedullary Screw

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.

Radiographic Study of the Fifth Metatarsal for Optimal Intramedullary Screw Fixation of Jones Fracture

2014 ◽  
Vol 36 (3) ◽  
pp. 293-301 ◽  
Author(s):  
George Ochenjele ◽  
Bryant Ho ◽  
Paul J. Switaj ◽  
Daniel Fuchs ◽  
Nitin Goyal ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Radiographic Study ◽  
Jones Fracture ◽  
Intramedullary Screw

Recurrence of Jones Fracture After Intramedullary Screw Fixation

2013 ◽  
Vol 18 (1) ◽  
pp. 21-24
Author(s):  
David Brown ◽  
Kyle Sanders ◽  
Drew Farrar ◽  
Joshua Newton ◽  
Adam J. Thompson ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Jones Fracture ◽  
Intramedullary Screw

In a small retrospective cohort of patients with syndesmotic injury, only athletes benefited from placement of a suture button device: a pilot study

2018 ◽  
Vol 4 (1) ◽  
pp. 21-25
Author(s):  
Joseph J Kromka ◽  
Monique C Chambers ◽  
Adam Popchak ◽  
James Irrgang ◽  
MaCalus V Hogan
Keyword(s):  
Pilot Study ◽  
Patient Reported Outcomes ◽  
Screw Fixation ◽  
School Level ◽  
High Demand ◽  
High School Level ◽  
Level Of Evidence ◽  
Suture Button ◽  
Phone Calls ◽  
Patient Reported

ObjectivesInjuries to the ankle are common, with a significant number of ligamentous injuries involving the syndesmosis. In syndesmotic injuries severe enough to require surgical fixation, the two leading techniques are rigid screw and suture button fixation. The literature has shown that both techniques are effective, but there remains debate on the optimum method of treatment. The goal of this study was to evaluate patient-reported outcomes for these repair methods in a population of athletes.MethodsThis study was a retrospective cross-sectional study of patients who had undergone rigid screw or suture button fixation for an injury to the ankle syndesmosis. Specifically, a subpopulation of athletes was examined as it was hypothesised that these high-demand patients would have higher patient-reported outcomes with ongoing suture button fixation. Study participants were identified through a search of the medical record and were recruited through mailed letters and phone calls. Participants completed patient-reported outcome questionnaires including the Activities of Daily Living and Sports Subscales of the Foot and Ankle Ability Measure (FAAM) survey, FAAM Sports Subscale survey, Veteran’s Rand 12-item Health Survey (VR-12) and a customised athletic activity questionnaire. These patient-reported outcomes were compared between those who underwent screw fixation and those who underwent suture button fixation.Results32 patients completed the study, with 17 of these designated as ‘athletes’ competing in strenuous sports activities that involve jumping, cutting and hard pivoting including football, soccer, basketball, volleyball and gymnastics at the high school level or above. Patients were on average 3.9 years post op (SD 2.2). With the numbers available, no difference in outcomes between patients with rigid screw or suture button fixation was observed in the study as a whole. In a subpopulation of athletes, patients who received suture button fixation had higher FAAM scores compared with those treated with rigid screw fixation (p=0.02). Still, in the subpopulation of athletes, no statistical difference was observed with the available numbers for the other patient-reported outcomes.ConclusionThis pilot study of outcomes in an athletic population suggests that athletic patients may benefit from suture button fixation and lays the groundwork for future work examining the use of suture button fixation in high-demand patients.Level of evidenceLevel III—Retrospective Comparative Study.

scholarly journals Assessing Elite Athletes Using PROMIS Tools: The STEALTH Project (Student Athlete Health Assessment)

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
Shanthan Challa ◽  
Marissa Holliday ◽  
Kenneth Bartolomei ◽  
Jonathan Bartolomei
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Computerized Adaptive Testing ◽  
Elite Athletes ◽  
Assessment Tools ◽  
Pain Interference ◽  
Significant Difference ◽  
Patient Reported ◽  
Division 1 ◽  
The Impact

Objectives: Injuries are a major part of elite sports, and patient-reported outcomes tools (PROs) are becoming commonplace for the assessment of injury and treatment outcomes. The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools with increasing popularity. The PROMIS metrics utilize computerized adaptive testing (CAT) to capture health status measurements through individualized assessments, with minimal user burden, and without the loss of precision or content validity. The purpose of this study was to evaluate elite athletes using PROMIS scores and assess the impact of injury on those scores to gain insight into how participation and injury can impact the health of NCAA Division 1 athletes participating in a variety of sports. Methods: Over six months, athletes from 11 sports at a single Division 1 Athletics program were recruited to participate in longitudinal prospective data collection using four PROMIS CAT scales/domains: Pain Interference (PI), Physical Function (PF), Depression, and Ability to Participate in Social Roles and Activities (PSRA). Using REDCap (Research Electronic Data Capture), athletes completed an assessment that included the PROMIS tools before participation in their respective sport’s season for the 2018-2019 academic year and following the completion of their season. Athletes suffering a season-ending injury were asked to complete the PROMIS survey within a week following the injury. De-identified data was analyzed using Student’s T-test. PROMIS outcome measures were analyzed using linear mixed model regression. A p-value of < 0.05 was considered statistically significant. Results: A total of 592 surveys were collected, composed of 320 pre-season surveys, 241 post-season surveys, and 31 season altering injury surveys. PF, Depression, and PSRA scores were significantly different in athletes than in the general age-matched population (Fig 1). PI scores were similar to the normal population. The distribution of PI and PF scores were significantly different pre and post-season with a difference in means of 1.499 (p=0.030) and -2.019 (p=0.005), respectively. No significant difference was observed in the Depression and PSRA scores at the end of the season (Fig 1). A total of 31 significant injuries were reported. Injuries resulted in a significant change from pre-season to post-season scores amongst all participants (Fig 1). Conclusion: There were significantly worse pain interference and physical function scores post-season compared to preseason, suggesting that athletic participation alone may impact the athlete’s overall function and condition. Season-altering injuries resulted in clinically significant differences in all four domains, PI, PF, Depression, and PSRA, suggesting that injuries greatly affect athletes not only physically, but mentally and socially as well. Statistically significant changes were seen in depression and social metrics after injury compared to the athlete’s pre-season scores. Consideration should be given to index pre-season PROMIS scores for individual athletes to make follow-up scores athlete-specific, meaningful, and actionable. There is a clear need for additional investigation into the impact of specific sports and specific injuries, which would be valuable to trainers, coaches, and clinicians to inform treatment and return to sport protocols.

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