Failed Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Fracture (Jones Fracture) in a Division I Athlete: A case report

Wukich, Dane K.

doi:10.3827/faoj.2009.0206.0001

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Watson et al [ 38 ] noted that delayed unions in Zone 2 and 3 fractures are often a result of choosing screws that are smaller than 4.5 mm in diameter. In the case of athletes, according to Wukich et al [ 40 ], it is advisable to use larger solid screws as a way of countering the higher amount of torsional stress directed towards the fracture site. Similarly, in the case of nonunion and refractures in Zones 2 and 3, Cheung and Lui[ 9 ] recommend treatment with medullary curettage and intramedullary screw fixation or inlay grafting.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Albloushi¹,

Alshanqiti²,

Qasem³

et al. 2021

WJO

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Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.

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Section: Postoperative Complicationsmentioning

confidence: 99%

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Albloushi¹,

Alshanqiti²,

Qasem³

et al. 2021

WJO

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“…They propose using a larger diameter screw, up to 6.5 mm in diameter screw to fixate the Jones fracture in competitive athletes. 5…”

Section: © the Foot And Ankle Online Journal 2009mentioning

confidence: 99%

Intramedullary Fixation of the Jones Fracture: A case report

Kline¹

2009

FAOJ

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The Foot and Ankle Online Journal 2 (6): 2 Intramedullary fixation of the Jones Fracture is described in this case report. Advantages of this procedure include percutaneous fixation of a Jones fracture without the need for traditional open reduction and a more rapid return to weightbearing and activity. The procedure is not technically difficult and provides excellent compression strength. This technique is indicated in stress fracture and/or fractures of a single cortex involving the fifth metatarsal.

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“…4 In spite of excellent results regarding intramedullary screw fixation for proximal fifth metatarsal fractures, screw breakage or bending has been reported and seems to be related to postoperative early weight-bearing, high patient body mass index (BMI), and the use of undersized screws. [5][6][7] An intramedullary screw fitting tightly may be of paramount importance.…”

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confidence: 99%

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

Sauer

2017

Surg J

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First described by Kavanaugh et al in 1978, intramedullary screw fixation is still indicated for proximal fifth metatarsal fractures.1 The simple percutaneous technique allows stable fracture fixation and thus early postoperative weight-bearing and rapid return to preinjury level of competitive sport. 2However, in terms of prognosis, tuberosity avulsion fractures (►Fig. 1; zone 1) must be distinguished from both traumatic fractures at the metaphyseal-diaphyseal junction (true Jones fracture; ►Fig. 1; zone 2) as well as proximal diaphyseal stress fractures (►Fig. 1; zone 3). The latter are a result of repetitive loading leading to failure of the skeletal structure and are associated with longer consolidation times and complications.3 Pes cavus and hindfoot varus foot alignment has been identified to potentiate cyclic loading onto the fifth metatarsal, which favors the incidence of a stress fracture. What is more, diaphyseal blood supply of the fifth metatarsal is ensured solely by the nutrient artery and may therefore be compromised when a diaphyseal fracture occurs, which may subsequently impede fracture healing. 4 In spite of excellent results regarding intramedullary screw fixation for proximal fifth metatarsal fractures, screw breakage or bending has been reported and seems to be related to postoperative early weight-bearing, high patient body mass index (BMI), and the use of undersized screws. 5-7 An intramedullary screw fitting tightly may be of paramount importance. Case ReportA 19-year-old male professional basketball player presents with pain to the lateral border of his left foot. The symptoms commence immediately after perceiving a snap to the left foot while attempting to jump. Forced inversion or flexion of the foot during injury is denied. Radiographs confirm a transverse stress fracture of the fifth metatarsal (►Fig. 2). Upon clinical examination, bilateral pes cavus and hindfoot varus alignment including peek-a-boo heel sign is observed (►Fig. 3A, B). The patient is scheduled for intramedullary screw fixation with a 4.5-mm cannulated screw. Surgical TechniqueThe surgical procedure was performed in regional anesthesia. The fracture was identified using a fluoroscan C-arm, and a small incision was made proximal to the base of the fifth metatarsal. An intramedullary guidewire was inserted into the fifth metatarsal and placed across the fracture site. The guidewire was then overdrilled protecting the soft tissue and tendon attachment with a drill sleeve. Counterpressure was placed along the longitudinal axis of the fifth metatarsal, and a correct length screw was inserted and tightened. All threads were placed distal to the fracture site. The screw head was embedded into the cortical part of the styloid Keywords ► intramedullary screw fixation ► proximal fifth metatarsal fracture ► pes cavus ► hindfoot varus AbstractIntramedullary screw fixation of proximal fifth metatarsal fractures is a simple surgical procedure, enabling early postoperative weight-bearing and subsequently rapid return to competitiv...

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Failed Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Fracture (Jones Fracture) in a Division I Athlete: A case report

Cited by 3 publications

References 19 publications

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Intramedullary Fixation of the Jones Fracture: A case report

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

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