Fifth Metatarsal Jones Fracture
David A. Porter M.D. PhD.
In the May 2005 issue of the American Journal of Sports Medicine with the help of Melissa Duncan and Dr. Susan Meyer, I evaluated the optimal screw choice in the treatment of fifth metatarsal Jones fractures, a common injury among the athletic population. This type of fracture, which is located in the lateral mid-foot area, has been treated both operatively and non-operatively. However, operatively is the recommend treatment for athletes. To date, both bone grafting and screw fixation inside the bone has been preferred surgical options. However, it has yet to be determined which of these options, or screw size is best.
Screw fixation inside the bone is popular among many surgeons and patients because it allows for a quicker recovery period, compared to bone grafting without screw fixation. With any form of treatment, athletes have been known to “re-fracture” the bone. We believe this risk is lower with the screw fixation and the rate of re-injury is 4 – 8 percent.
Based on this information, our team set out to determine if the use of a 4.5-mm cannulated screw for the treatment of a Jones fracture would be an effective approach. We performed the surgery on approximately 23 athletes and provided rehabilitation support.
Postoperative rehabilitation included performing immediate range of motion exercises, applying cold compression therapy, wearing a removable walking boot for approximately four weeks, and walking with crutches for approximately seven days. After three to five days following the first postoperative visit the patients were allowed to be full weight-bearing with crutches and were then weaned off the crutches as swelling and pain allowed. A foot orthosis, or in-shoe foot brace, was recommended for use until the athletes had completed their competitive athletic career.
Additionally, stationary bicycle aerobic fitness was initiated at the first return visit, typically three to five days after surgical screw fixation. Stair-stepper training was begun when the athlete was weaned out of the walking boot. Running was begun at four to five weeks postoperatively if the athlete was pain free with stair-stepper exercise training. A functional progression program was initiated when the athlete was pain free with running three to four days a week for 30 minutes. Once that had been completed, pain free and without apprehension, the patient was granted clearance to return to their designated sport.
In the end, all the athletes returned to their designated sport after an average of seven and a half weeks. There were no reported complications, no lasting nerve damage and the wounds healed properly. Since the study began in 1997, none of the athletes have required removal of the screw and no athlete has complained of pain at the surgical site. Based on these assessments, we were able to determine that fixation with a stainless steel, 4.5-mm, cannulated screw gives reliable and effective healing in fifth metatarsal stress fractures.