Jones Fracture in the Elite Athlete: Patient Reported Outcomes following Fixation with BMAC

Carney, Dwayne; Chambers, Monique C.; Kromka, Joseph; LaBaze, Dukens; West, Robin V.; Musahl, Volker; Lesniak, Bryson P.; Hogan, MaCalus V.

doi:10.1177/2325967118s00160

Cited by 5 publications

(4 citation statements)

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“…PROMIS PF and PROMIS PI improved significantly after surgery. While Carney et al [ 6 ] did not show specific PROMIS scores in their abstract, they noted improvement in PROMIS10 scores (a global PROMIS domain) at 12 months. In addition, they found that patients had significantly improved visual analog scores (VAS) for pain, foot and ankle ability measure (FAAM) scores, patient acceptable symptom state (PASS) at 6 months postoperatively.…”

Section: Discussionmentioning

confidence: 96%

“…However, controversy still exists on the mode of fixation required for optimal results. Current management techniques have shown the efficacy of intramedullary screw fixation [ 6 – 8 ] although the optimal characteristics of the screw (length and diameter) are still debated. This study aims to determine how better anatomical understanding translates to patient-reported outcomes using PROMIS CAT surveys.…”

Section: Discussionmentioning

confidence: 99%

“…Ho et al recently validated PROMIS, but did not apply PROMIS to individual procedures [ 22 ]. To our knowledge, only Carney et al [ 6 ] have looked at PROMIS as it relates to intramedullary fixation of the proximal fifth metatarsal. We are the first group to correlate radiographic variables with PROMIS scores pre- and postoperatively and to stratify these results by gender.…”

Section: Discussionmentioning

confidence: 99%

“…This area, at the metaphyseal-diaphyseal junction, has been described as a watershed zone due to poor blood supply; consequently, fractures treated nonoperatively in this zone have an increased risk of nonunion [ 4 ]. Evidence suggests that intramedullary compression screw fixation is indicated in competitive athletes and can decrease healing time and rates of nonunion in the general population [ 6 – 8 ]. Similarly, a trial of conservative management may be attempted for acute zone 3, or proximal diaphyseal, fractures, but operative treatment may be required if there are clinical or radiographic signs of delayed union or nonunion [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

et al. 2021

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Background Zones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes. Methods We retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender. Results The average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=−0.478; p=0.045). Metatarsus adductus angle (r=−0.606; p=0.008), lateral talo-1st metatarsal angle (r=−0.592; p=0.01), and medial cuneiform height (r=−0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=−0.7526; p=0.005), lateral talo-1st metatarsal angle (r=−0.7539; p=0.005), and medial cuneiform height (r=−0.627; p=0.029). Conclusion Patients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%