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

Albloushi, Mohammad; Alshanqiti, Amer; Qasem, Mohammad; Abitbol, Andreas; Grégory, Thomas

doi:10.5312/wjo.v12.i9.640

Cited by 10 publications

(8 citation statements)

References 49 publications

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“…In elite athletes, however, the rate of refracture can be as high as 30% for IM screw fixation and 10.5% for plate fixation [ 34 , 35 ]. Operation-related complications include wound infection, delayed wound healing, sural nerve injury, hardware failure, refracture, malunion, delayed union/nonunion, a prominence of screwhead, chronic low-level pain, and iatrogenic fracture [ 32 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

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Jones Fracture in the National Football League

Luo,

Anastasio,

Stauffer

et al. 2023

Sports

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Background: Jones fracture, or proximal fifth metatarsal fracture, is a common injury in National Football League (NFL)-caliber athletes. Combine draft performance can greatly impact the long-term success of these athletes, and substantial emphasis has been placed on early return to play (RTP) and the minimization of post-operative complications after Jones fracture in these athletes. To date, no study has specifically described the treatment and outcomes of this injury specifically in NFL-caliber players, considering factors relevant to this unique population. Thus, the purpose of this review is to delve into Jones fracture in NFL-caliber athletes, evaluating the diagnostic, treatment, and RTP considerations. Methods: We searched Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCOhost) for the concept of Jones fractures in the NFL. Using the PRISMA guidelines, a team of three reviewers conducted abstract screenings, full-text screenings, and the extraction of studies describing Jones fractures specifically in the NFL. Results: Of the 1911 studies identified, 6 primary retrospective studies met the inclusion and exclusion criteria. The heterogeneity of the outcome reporting precluded a meta-analysis; thus, a qualitative review of manuscripts describing Jones fracture was carried out. Classification, diagnosis, and treatment considerations, RTP statistics and outcomes, and complications were discussed. Amongst the primary studies, there were 285 Jones fractures, all athletes were able to RTP, and the average time to RTP ranged from 6 weeks to 27 weeks. For complications, with operative treatment, the refracture rate ranged from 4 to 12%, and incomplete healing ranged from 7 to 50%. RTP was 15 weeks for refractures. There were no patient-reported outcomes. Conclusions: The vast majority of Zone 2/3 Jones fractures are treated with IM screw fixation with or without adjunctive orthobiologics, such as bone marrow aspirate concentrate, in NFL-caliber athletes. The six major series investigating outcomes after the operative treatment of Jones fractures in NFL players reveal very positive findings overall with regard to RTP, reoperation, and career continuation.

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Section: Resultsmentioning

confidence: 99%

“…Amongst the NFL athletes studied, the incidence of operation-related complications was essentially zero [ 14 , 36 ]. Instead, the primary complications affecting NFL athletes include either refracture or incomplete healing [ 2 , 6 , 14 ].…”

Section: Resultsmentioning

confidence: 99%

Jones Fracture in the National Football League

Luo,

Anastasio,

Stauffer

et al. 2023

Sports

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“…The effectiveness of surgical fixation in Jones fractures has been a subject of interest, with providing insights into the fixation methods for Jones type fifth metatarsal fractures in athletes. 36 Their review highlighted the common occurrence of Jones fractures among athletes and the importance of appropriate fixation techniques to promote successful healing and minimize complications. Surgical interventions, particularly involving screw fixation, have shown promising results in promoting union and reducing the risk of delayed unions or nonunions.…”

Section: Discussionmentioning

confidence: 99%

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

Kacprzak,

Krzymińska,

Siuba

et al. 2024

J Educ Health Sport

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This study presents the rehabilitation process for the management of six cases of fractures of the fifth metatarsal bone in players of various sports playing at high levels of competition in Poland. The course of treatment was based on an intensive rehabilitation protocol with the need for orthopaedic shoe inserts, with full weight bearing on the limb and under close supervision of a physiotherapist. The effectiveness of rehabilitation was assessed by physical examination, X-ray examination and the numerical pain rating scale - NRS. This study focuses on the rehabilitation process for managing fractures of the fifth metatarsal bone in high-level athletes in Poland. The treatment involved an intensive rehabilitation protocol with orthopaedic shoe inserts, full weight bearing, and physiotherapist supervision. The effectiveness of rehabilitation was evaluated through physical exams, X-rays, and the numerical pain rating scale. Introduction Fractures of the fifth metatarsal bone are common in athletes aged 10-29, especially in football, basketball, and dance. Complications include delayed bone fusion and repeat fractures, emphasizing the importance of quick return to fitness. The involvement of physiotherapists and patient positivity is crucial. The debate among clinicians stems from classification variations and interpretations of 'Jones fractures'. Diagnostic and Classification Methods The Lawrence and Bottle classification distinguishes three types of metatarsal fractures: avulsion, Jones, and fatigue fractures. The study presents six cases of conservative treatment for these fractures, showing positive outcomes in returning athletes to competition. Rehabilitation Procedure Patients underwent functional treatment with orthopaedic insoles, immediate weight-bearing, and various therapies like Orthokine®, Exogen, hyperbaric chamber sessions, ESWT, and EPTA. Post-workout treatments included Game Ready®, flossing, manual therapy, dry needling, and lymphatic drainage. Patients also engaged in self-managed rehabilitation exercises. Treatment Results Radiographic examinations showed progressive healing in all cases, with reduced pain and no edema after two weeks. Patients returned to sports within three weeks, with no complaints after 13 months. The study highlights the success of functional treatment in achieving full recovery without complications. Conclusion The study challenges the need for surgical intervention and immobilization in treating fifth metatarsal fractures. Functional treatment led to excellent outcomes and quick return to sports. Literature review supports early mobilization and functional therapy for optimal results. Further research is needed to establish a standard treatment protocol based on evidence-based medicine.

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“…We read with interest a review article from Albloushi et al [ 1 ], who present an excellent overview of pathoanatomy, classification, and current concepts of fixation modalities for Jones type fifth metatarsal fracture. We thank the authors for this valuable contribution, and we agree with their conclusion that there remains a lack of consensus on the effective management of Jones fractures, especially in the high-level athlete group.…”

Section: To the Editormentioning

confidence: 99%

Existing fixation modalities for Jones type fifth metatarsal fracture fixation pose high rates of complications and nonunion

Anastasio¹,

Parekh²

2022

WJO

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Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon, given documented high nonunion rates as well as high complication rates including hardware prominence, nerve injury, and screw breakage for existing treatment modalities including screw and plantar plate fixation. We call for the design of innovative Jones-fracture specific implants which contour to the natural curve of the fifth metatarsal. Future research should aim to expand upon existing literature for Jones fracture fixation and evaluate efficacy of novel implants which are designed to address unacceptably high complication rates for existing treatment modalities.

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

Cited by 10 publications

References 49 publications

Jones Fracture in the National Football League

Jones Fracture in the National Football League

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

Existing fixation modalities for Jones type fifth metatarsal fracture fixation pose high rates of complications and nonunion

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