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Can You Run Again After Getting Rod Screws

  • Journal List
  • Orthop J Sports Med
  • v.8(iv); 2020 Apr
  • PMC7219008

Orthop J Sports Med. 2020 April; eight(4): 2325967120912423.

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

Scott Watson

†Blue Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Wellness–Upstate, Seneca, Due south Carolina, USA.

Amy Trammell

‡Section of Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.

Stephanie Tanner

§Section of Orthopedic Surgery, Prisma Health–Upstate, Greenville, South Carolina, Usa.

Steven Martin

†Blue Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Health–Upstate, Seneca, South Carolina, USA.

Larry Bowman

†Bluish Ridge Orthopedics, Department of Orthopedic Surgery, Prisma Health–Upstate, Seneca, Southward Carolina, The states.

Abstract

Background:

There is disagreement among team physicians, without conclusive testify, as to when loftier-level athletes with a Jones fracture should be immune to return to play after existence treated operatively with an intramedullary spiral.

Purpose:

To written report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones fractures.

Written report Design:

Case series; Level of show, 4.

Methods:

We identified all collegiate athletes with an acute fracture at the base of the fifth metatarsal treated past one 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 unmarried intramedullary screw. Athletes were immune to bear weight every bit tolerated in a walking boot immediately postoperatively and render to play every bit soon every bit they could tolerate activity. Patients were contacted to complete patient-reported result scores that included the Foot and Ankle Power Measure out (FAAM) score, a cursory survey specific to our study, and follow-up radiographs.

Results:

A total of 26 astute 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.six weeks (range, ane.5-6 weeks). 3 screws were removed for symptomatic skin irritation. There was 1 refracture after spiral removal that was done after radiographic and clinical documentation of fracture marriage, which was treated with echo cannulated percutaneous screw fixation. One spiral was observed on radiographs to be cleaved at i twelvemonth postoperatively, but the fracture was healed and the athlete was playing National Collegiate Able-bodied Clan Sectionalisation I sports without symptoms and connected to play professionally without symptoms. Of 25 athletes, xix completed the FAAM at an average follow-upward of 8.vi years (range, i.5-20.0 years). They reported scores of 94.ix% (range, 70.2%-100%) for the activities of daily living subscale and 89.ane% (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 tin safely be immune to return to play subsequently intramedullary screw fixation as before long every bit their symptoms let, without pregnant complications. In our experience, this is commonly within 4 weeks from injury.

Keywords: Jones fracture, intramedullary screw fixation, athletes, return to sport

The fifth metatarsal is the about normally fractured metatarsal in the foot, comprising approximately seventy% of all metatarsal fractures; such fractures are relatively common in immature athletes.22 Dr Robert Jones10 starting time described fractures of the proximal aspect, or base of the fifth metatarsal, in 1902. The radiographic anatomy of the fracture is crucial for treatment decisions, equally not all 5th metatarsal fractures are considered "Jones fractures." Fractures can be classified using the Torg classification as follows: type I, fracture on the lateral aspect of the tuberosity, extending proximally into the metatarsocuboid joint; type Two, Jones fracture, beginning laterally in the distal part of the tuberosity and extending obliquely and proximally into the medial cortex at the fourth and fifth metatarsal base articulation; and type III, fracture distal to the quaternary and 5th metatarsal base articulation. Lawrence and Botte14 also classified these fractures based on the zone of injury: proximal tuberosity avulsion fractures caused past backlog inversion of the foot (zone I), metaphyseal-diaphyseal junction (zone II), considered truthful "Jones fractures," and diaphyseal fractures, distal to the fourth and 5th metatarsal articulation (zone Three). More recent studies1,12 have included both zone II and zone Iii fractures when describing Jones fractures, as they accept similar healing patterns, with a high risk of nonunion.

The delayed and decreased healing rates of zone Two and zone 3 fractures are attributed to the beefcake of the blood supply of the fifth metatarsal. A "water-shed" expanse is present at the metaphyseal-diaphyseal junction, as the base of operations of the metatarsal is perfused by metaphyseal arteries that enter at the base, whereas the nutrient arteries enter the proximal shaft and provide retrograde perfusion to the metaphyseal-diaphyseal junction.24 To further complicate this matter, the nutrient artery that supplies the watershed area is often compromised by zone 2 and zone 3 fractures.3,24 Athletes are specially susceptible and predisposed to nonunion and refracture considering of the excessive repetitive stress the bone must suffer. Kavanaugh et al11 and DeLee et al4 reported a loftier rate of delayed union or nonunion in athletes treated nonsurgically.

Intramedullary fixation in the treatment of Jones fractures is accustomed among team physicians as the standard of care in elite athletes to optimize outcomes and expedite render to play.2,5,7,9,12,17 A 2011 systematic review26 reported that operative fixation with intramedullary screw fixation results in faster fourth dimension to marriage and faster render to play with fewer complications compared with nonoperative management. Despite early surgical fixation and improvement in surgical techniques, the published nonunion and refracture rate of 4%-12% persists.eighteen,23 While information technology has become widely accepted that operative fixation facilitates an early return to sport, at that place is limited information on when an athlete is accounted set to return to play without compromised fracture healing. Some authorsvii,13,23 take hypothesized that surgical failure is the result of returning to vigorous activity too soon. Yet, even in studieseight,9,23,28 with prolonged protected weightbearing postoperative protocols, a loftier ratio of patients with nonunions and refractures was demonstrated. Controversy persists among physicians and sports medicine teams on the timing of render to play and the platonic postoperative protocol.

The purpose of this study was to written report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones fractures.

Methods

Institutional review board approval was obtained for this report. A retrospective review of the injury database of ii collegiate able-bodied programs treated by our do was performed, and all patients with fifth metatarsal fractures from Baronial 1994 through December 2015 were identified. Inclusion criteria were as follows: age ≥18 years, skeletal maturity, collegiate-level athlete at time of injury, surgical fixation with intramedullary screw, and a fifth metatarsal Jones fracture (Lawrence and Botte zone 2 and zone III, Torg Three27) as identified on anteroposterior (AP), lateral, and oblique radiographs. All operative fractures included in the study were complete, acute fractures equally indicated radiographically; no stress reactions or stress fractures were treated operatively and included in this serial. Individuals were excluded if they had a previous injury to the ipsilateral human foot.

Render to play was defined every bit competing in intercollegiate competition (in-flavor athletes) or full participation in practice/preparation without limitations (out-of-season athletes). This was documented prospectively by able-bodied training staff in the National Collegiate Athletic Clan (NCAA) injury database at the collegiate institutions. Certified able-bodied trainer records from each university were used to identify athlete characteristics, length of follow-up at the academy, and any complications afterwards surgical fixation.

Operative reports of all the included patients were reviewed. Details of fracture morphology, and implant details, including manufacturer, type (solid, cannulated, or variable pitch compression screw), and screw diameter, were recorded.

Afterwards the retrospective review, attempts were made to contact each patient to request new pes radiographs and participation in an online survey. The survey included the Pes and Ankle Power Measure (FAAM),16 which is divided into activities of daily living and sports subscales, as well as a brief questionnaire specific to our study (come across Appendix).

Surgical Technique

All surgical procedures were performed by i of ii authors (S.M. or 50.B.). The surgical technique used past each surgeon was identical, although the implant of choice differed over the 23-twelvemonth report collection period. All cases were performed utilizing a percutaneous intramedullary spiral fixation under fluoroscopy guidance. Afterwards identification of the base of the 5th metatarsal and the fracture site, a small incision was fabricated at the base of the fifth metatarsal at the intersection of the peroneus brevis and tertius tendon. Blunt dissection was used to create a soft tissue aeroplane. A guide wire was and then inserted to the tip of the base of operations of the 5th metatarsal in line with the intramedullary canal in multiple planes. Placement was confirmed with AP, lateral, and oblique views. The wire was avant-garde across the fracture site downwardly the intramedullary canal in a trajectory that would not penetrate the cortical bone. The canal was then prepared with drills and taps according to the technique of the specific implant called in each example, with a goal of placing a screw diameter large enough to adequately control the distal segment with show of torque on the fifth metatarsal shaft during tap and spiral placement. A depth measurement was taken from the wire, and a spiral of the appropriate length was selected to allow for the longest spiral possible without hitting the far cortex when using variable pitch screws. For partially threaded screws, solid or cannulated, a spiral length long enough to ensure that the threads would all be past the fracture site to attain lag spiral fixation was selected. Implants included standard AO cannulated screws (stainless steel; Synthes), variable pitch headless compression screws (titanium; Acumed), or solid Jones fracture–specific screw systems (titanium; Arthrex). Intendance was taken in all cases to obtain intramedullary fixation on AP, lateral, and oblique views, with adequate screw fixation distal to the fracture site.

Postoperative Protocol

Postoperative rehabilitation was divided into 5 phases, as outlined in Table 1. Patients progressed through each stage sequentially based on proper technique and tolerance of the additional workload. Rehabilitation was focused on ensuring the maintenance of proper gait, with gradual progression of workload while maintaining conditioning in apprehension of return to full participation. Throughout this process, the athlete was allowed to participate in all team weight-lifting sessions in a modified manner, to maintain upper and lower trunk force. The fourth dimension required to progress through each phase was athlete dependent, but it was generally 4-7 days. Of note, our protocol includes a bone stimulator to promote healing and decrease the recovery fourth dimension in this challenging fracture pattern and patient population. Routine radiographs to document fracture healing were non routinely taken unless the athlete's symptoms were non progressing and pain was not decreasing appropriately with attempted return to play or total training by 6-8 weeks postoperatively.

Table ane

Postoperative Rehabilitation Protocol for Jones Fractures

v Phases of Postoperative Rehabilitation for Jones Fractures Protocol
Phase I Immediately postoperation. Patient allowed toe-touch weightbearing every bit tolerated in a walking boot and crutches. Discontinued use of crutches as before long as tolerable. Patient is to utilise the os stimulator twice a mean solar day and perform 4-style (plantarflexion, dorsiflexion, inversion, and eversion) ankle-resisted exercises twice a day (3 sets of 20 reps).
Phase II Patient is avant-garde to full weightbearing in a walking boot. Utilize of the bone stimulator and ankle exercises are continued twice daily. Patient trains with underwater treadmill one time a solar day for 20 min at a speed of 2.v-iii.0 mph (water depth is breast meridian). Speed of the treadmill, amount of jet water resistance, and decrease in h2o depth are avant-garde as tolerated. By the end of phase II rehabilitation, patient should exist able to do interval preparation for 20 min at waist-depth h2o. An instance of interval training protocol is as follows: lx seconds at five-six mph pace followed past 90-second run at 7-viii mph with jet resistance at approximately 45%-60% weightbearing.
Phase Iii Walking boot discontinued and replaced with cross-training shoes with orthotic or rigid inserts. Exercises are progressed to unmarried-leg dogie raises, dorsiflexion stretching exercises, and single-leg proprioception exercises. Progression to full weightbearing straight ahead running is continued. At the stop of phase III, athlete is progressed to limited change of direction and position-specific drill work in cross-training shoe. Os stimulation and resistance talocrural joint exercises continued twice daily.
Stage Four Patient is allowed to employ cleats with orthotic or rigid inserts. Full weightbearing running at full intensity is combined with change of direction and position-specific drill work. Unmarried-leg plyometric exercises are added. Connected employ of bone stimulator, resisted ankle exercises, single-leg dogie raises, dorsiflexion stretching exercises, and single-leg plyometric exercises. The goal of phase IV rehabilitation is express render to participation in exercise.
Phase V Patient is avant-garde from limited practice to full participation. Connected use of bone stimulator 2 times a 24-hour interval and all rehabilitation exercises until asymptomatic.

Results

During the study menstruum, 27 athletes were treated with surgical fixation of Jones fractures; still, ii athletes were excluded based on previous injuries to the ipsilateral foot, giving a full report population of 25 athletes. Ane patient fractured both of his fifth metatarsals during his collegiate career, and therefore, a total of 26 fractures were included in this study. The written report group was fabricated upwardly of 22 male and 3 female athletes, with an boilerplate historic period of 20 years (range, 18-23 years) and an average body mass index (BMI) of 28.4 (range, 21.6-38.vii). The study sample consisted of fourteen football players (56%), 2 basketball players, 7 soccer players (28%), 1 volleyball player (four%), and i tennis actor (4%).

Surgical fixation was achieved with intramedullary screw fixation in all cases. Implants included ten partially threaded cannulated screws, 13 cannulated variable pitch screws, and 3 solid screws. The screw blazon was chosen based on patient anatomy and surgeon preference and evolved over the 23 years of the report period. Meet Tabular array 2 for details on screws utilized for fixation.

Table 2

Screw Types

Screw Type (Material) n (%) Spiral Sizes
Partially threaded cannulated (stainless steel) ten/26 (38%) ii-4.0 mm
viii-iv.five mm
Variable pitch headless compression screw (titanium) 13/26 (50%) 10-four.7 mm
3-5.5 mm
Solid (titanium) iii/26 (12%) 2-4.5 mm
1-5.v mm

All study athletes returned to play within half dozen weeks of surgery, at an boilerplate of three.vi weeks (range, 1.v-6 weeks). In-flavor fractures made up 61% of the full. The boilerplate render to play for in-season injuries was 3 weeks (range, ii-4.v weeks). Out-of-season athletes returned to full activeness at an average of 4.vi weeks (range, 3-6 weeks). The breakup of timing of return to play is displayed in Figure 1.

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Number of athletes who returned to play by weeks after surgery. All midweek returns were rounded up to the nearest full calendar week.

No surgical wound complications or infections were recorded. Zero nonunions or malunions were identified radiographically or reported symptomatically. Of the 26 screws, 3 (11%) screws were removed because of soft tissue irritation. All 3 screws were partially threaded cannulated screws with a standard head, and the surgeries were performed early in the study menstruation (1990s), prior to electric current screw technology and the availability of fracture-specific screws. But 1 athlete (4%) suffered a refracture. Half-dozen months after the initial surgery in this patient, the screw was removed because of soft tissue irritation. The athlete then refractured the same fifth metatarsal 1 twelvemonth from the initial injury and was treated a second fourth dimension with revision intramedullary surgical fixation, returning to play within two weeks of surgery. He participated in the report survey and reported no other problems with his foot in the 16 years since his surgery.

Ane 4.0-mm cannulated screw was incidentally identified as broken on an ankle radiograph at ane year postoperatively, but on further foot imaging, the fracture was healed and the athlete was playing NCAA Partition I basketball without lateral foot symptoms. Nosotros were unable to obtain an updated radiograph of this player during the study, but she was able to complete the FAAM study forms, where she reported minimal symptoms at ix-year follow-up (86% on the FAAM sports subscale and 100% on the FAAM activities of daily living subscale). In addition, this player has been playing professionally for 7 years and continues to exist asymptomatic. The only other incidence of broken hardware was a 4.5-mm cannulated screw identified in the study follow-upwards, with bridging callous and no appreciable fracture line visible on the radiograph taken for study purposes at 12 years postoperatively. The patient had completed his athletic career without whatsoever significant further foot pain or limitations and reported FAAM scores of 100% on the sports subscale and 100% on the activities of daily living subscale. Tabular array 3 summarizes the complications.

Table 3

Complications (N = 26 Patients)

Complication north (%)
Hardware removal because of soft tissue irrigation 3 (xi)
Refracture 1 (iv)
Broken hardware ii (eight)
Wound complications 0
Infections 0

A total of 20 one-time athletes with 21 fractures (84% of the full fractures included) participated in the patient survey, imaging, or both. Nineteen athletes (76% of the total athletes included) completed the FAAM at an boilerplate follow-up of 8.vi years (range, 1.5-20 years). Patients scored an average of 94.9% (range, 70.2%-100%) for the activities of daily living subscale and 89.i% (range, 42.9%-100%) for the sports subscale. When participants were asked to rate their current level of function during usual activities as a percentage of their preinjury level, they reported an average 93.9% (range, 70%-100%), with 14 of the 19 athletes reporting >95% of preinjury function. When asked to charge per unit their current level of sports activity every bit a pct of their preinjury level, participants reported an boilerplate of 90.three% (range, 40%-100%), with eleven of the 19 athletes reporting >95% render of able-bodied function. Table four summarizes the results of the patient-reported outcomes.

Table 4

Patient-Reported Outcomes (n = 19) a

Outcome Measure Average Score (Range)
FAAM activities of daily living subscale 94.9% (70.2%-100%)
FAAM sports subscale 89.1% (42.9%-100%)
Percent of preinjury daily function 93.9% (seventy%-100%)
Percentage of preinjury sports office xc.3% (40%-100%)

Long-term follow-upwards radiographs (>1 twelvemonth) were obtained on 14 of 26 (54%) fractures at an boilerplate of 6.v years postoperatively (range, i.2-xvi.5 years). Of those who participated in the survey or had long-term follow-up radiographs (84%), there were no reported refractures or additional surgery of the included fifth metatarsal.

Give-and-take

In our accomplice, we did not observe any nonunions or fracture-related complications afterward Jones fracture fixation, with an accelerated average return to play of 3.6 weeks (<6 weeks for all athletes). While an early return to play without radiographic show of union remains controversial, we only observed one refracture (4%), and this was one twelvemonth from the initial injury and later on the screw had been removed for soft tissue irritation 6 months subsequently the master fixation process. Even if this is considered a true refracture, our results did non demonstrate a college refracture charge per unit than previous studies in high-level athletes returning to play.seven,ix,12,18,23 These studies described a much longer recovery before return to sport than nosotros describe in our current protocol, only failed to demonstrate superior outcomes.

Debate continues among team physicians well-nigh when athletes should be allowed to return to play and what criteria must be met. Our protocol for 22 years has been to apply clinical progression of symptoms as the guide for return to play, and this study demonstrates first-class clinical results with this. We believe that our results are related to early stable surgical fixation combined with routine bone stimulator use as well as a defined protocol of progression based on symptoms that allows the athlete to return to play quickly and safely. While virtually authors abet for radiographic evidence of healing before render to play, the results still vary. Glasgow et alviii reported on a series of fractures in athletes treated with 4.5-mm malleolar screws, and early return to play was associated with delayed union and refracture, suggesting the spiral diameter did not provide sufficient support to allow healing. Wright et al28 reported 6 refractures upon return to play despite all athletes showing radiographic healing before render to play. Lareau et al12 hypothesized that this high rate may take been related to the use of iv.0- and v.0-mm cannulated intramedullary screws that were undersized. However, in our serial, like cannulated iv.0- or four.five-mm implants were used in 38% of our cases, and nosotros did not detect the same complications.

A variety of implants were utilized over the long study period reported in this serial. Based on biomechanical studies demonstrating the superior strength of solid, indication-specific screws, previous authors have advocated for their use.20,21,25 While nosotros currently prefer indication-specific screws, we observed excellent early on return to play and long-term results with a low complexity charge per unit in our series, despite 38% of implants being cannulated screws and 50% being variable-pitch screws. This again points to accelerated rehabilitation and progression based on symptoms as the fundamental factors for successful return to play in our study, as opposed to implant selection alone. Nagao et al19 reported findings similar to ours in a series of Jones fractures in athletes treated with headless compression screws and an early on return to running at an boilerplate of 6 weeks.

Our study is not the showtime to depict return to play based on clinical symptoms. A study by de Oliveira Massada et al6 reported good results with 100% union rate in a series of 15 high-level athletes. The authors used the absenteeism of hurting on clinical examination and during concrete activities to indicate that an athlete was ready to render to sport, even in the absence of radiographic union. This series of athletes, a large majority of whom were soccer players, had an average return to play of seven.5 weeks (range, 2-12 weeks). Lareau et al12 also ended that "physical exam and ability to return to play are as important as degree of radiographic healing" when determining the timing of return to play and reported an average return to play of in-flavor National Football League athletes of 8.7 weeks (range, five.9-xiii.6 weeks).

Several authors have attempted to place factors that contribute to poor outcomes in Jones fractures in athletes. Lee et alfifteen establish, in a large series of 163 elite athletes, that loftier BMI and radiographic protrusion of the fifth metatarsal head have a significant association with refracture after surgery and recommended that these athletes render to sport more than slowly. The average BMI of athletes in our study was 28.4, with excellent results.

This written report has several strengths. First, the study menstruum over 22 years is the longest published serial we are aware of, with an average follow-up greater than 8 years and 26 fractures included. Our patient population consisted of high-level collegiate athletes across a diversity of sports and included both male and female patients; return-to-play data were accurately recorded prospectively into a database by athletic trainers. Also, 2 experienced surgeons who work closely together, with the same surgical indications, performed the aforementioned surgical technique for all procedures.

We acknowledge the limitations of our report, most obviously the limitation of retrospective review of our clinical experience. Also, in that location was a lack of routine and long-term radiographic follow-up on 46% of patients, although 76% completed patient-reported outcomes. Altogether, 21 of 25 (84%) patients were reached for the written report follow-up, and based on the excellent issue scores reported, we feel it is rubber to presume at that place were no hardware complications or nonunions that radiographs would have elicited. In addition, near complications should take been axiomatic in this patient population at brusque-term follow-up during their collegiate able-bodied career, while they were being treated exclusively by our exercise. Additional limitations include the use of variable implants and the absenteeism of a control grouping.

Decision

Our study demonstrates that operative treatment of athletes with astute Jones fractures and a symptom-guided rehabilitation program allows athletes to return to play quickly without significant hazard. In our experience, and based on the results presented in this study, about (81%) returned to play in less than 5 weeks. Not only does this protocol result in early return to play, just it has demonstrated successful long-term outcomes as well.

Appendix

Jones Fracture Questionnaire

  1. Participant proper name:_________________

  2. Age at fourth dimension of injury (Jones fracture):_______

  3. College year at time of injury

    1. Redshirt freshman

    2. True freshman

    3. Sophomore

    4. Junior

    5. Senior

  4. In what sport were you participating at the time of injury?

    1. Baseball

    2. Basketball game

    3. Cantankerous-country

    4. Football

    5. Golf

    6. Rowing

    7. Soccer

    8. Tennis

    9. Track and field

    10. Volleyball

    11. Other (please specify):_________________

  5. How many years did you participate in your sport while at the university?

    1. Ane

    2. Two

    3. 3

    4. Iv

    5. V

  6. Did y'all suspension your foot in practice or competition?

    1. Practice

    2. Game/competition

    3. Other (delight specify):_________________

  7. What playing surface were you lot on at the time of injury?

    1. Grass

    2. Artificial turf

    3. Wooden flooring (basketball/volley courtroom)

    4. Concrete/asphalt

    5. Other (please specify):_________________

  8. In your opinion, were you able to recover to your competitive level earlier injury?

    1. Yes, full recovery

    2. No

  9. If yous answered no to question eight, delight specify how your injury affected your competitive play

    1. Time off for recovery

    2. Pain

    3. Foot numbness

    4. Refracture

    5. Other (please specify):_________________

  10. Since having surgery to treat the fracture, have yous injured your foot?

    1. Yes (please explain):_________________

    2. No

Footnotes

Final revision submitted November 29, 2019; accepted Dec 17, 2019.

One or more of the authors has declared the following potential disharmonize of involvement or source of funding: S.Westward. has received educational back up from Arthrex and Peerless Surgical and hospitality payments from DePuy, Smith & Nephew, and Stryker. South.G. has received speaking fees, consulting fees, and royalties from Arthrex; educational back up from Arthrex and Peerless Surgical; and hospitality payments from Smith & Nephew. 50.B. has received educational back up from Arthrex and Peerless Surgical. AOSSM checks writer disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Upstanding approval for this study was obtained from Greenville Wellness System (file No. Pro00053666).

References

1. Chuckpaiwong B, Queen RM, Easley ME, Nunley JA. Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clin Orthop Relat Res. 2008;466(8):1966–1970. [PMC free article] [PubMed] [Google Scholar]

2. Clapper MF, O'Brien TJ, Lyons PM. Fractures of the fifth metatarsal. Assay of a fracture registry. Clin Orthop Relat Res. 1995;315:238–241. [PubMed] [Google Scholar]

3. Dameron TB., Jr Fractures of the proximal fifth metatarsal: selecting the best handling option. J Am Acad Orthop Surg. 1995;3(2):110–114. [PubMed] [Google Scholar]

4. DeLee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med. 1983;eleven(5):349–353. [PubMed] [Google Scholar]

5. Den Hartog BD. Fracture of the proximal 5th metatarsal. J Am Acad Orthop Surg. 2009;17(vii):458–464. [PubMed] [Google Scholar]

6. de Oliveira Massada MMT, Pereira MANPG, de Sousa RJG, Costa PG, da Rocha Massada JL. Intramedullary spiral fixation of proximal fifth metatarsal fractures in athletes. Acta Ortop Bras. 2012;20(v):262–265. [PMC free commodity] [PubMed] [Google Scholar]

7. Ekstrand J, van Dijk CN. Fifth metatarsal fractures among male professional person footballers: a potential career-catastrophe disease. Br J Sports Med. 2013;47(12):754–758. [PubMed] [Google Scholar]

viii. Glasgow MT, Naranja RJ, Glasgow SG, Torg JS. Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture. Foot Ankle Int. 1996;17(8):449–457. [PubMed] [Google Scholar]

ix. Japjec K, Starešinić Grand, Starjački M, Žgaljardić I, Štivičić J, Šebečić B. Treatment of proximal 5th metatarsal os fractures in athletes. Injury. 2015;46(suppl 6):S134–S136. [PubMed] [Google Scholar]

ten. Jones RI. Fracture of the base of operations of the 5th metatarsal bone by indirect violence. Ann Surg. 1902;35(6):697–700. [PMC free commodity] [PubMed] [Google Scholar]

11. Kavanaugh JH, Brower TD, Isle of man RV. The Jones fracture revisited. J Bone Joint Surg Am. 1978;sixty(6):776–782. [PubMed] [Google Scholar]

12. Lareau CR, Hsu AR, Anderson RB. Return to play in National Football League players subsequently operative Jones fracture treatment. Pes Ankle Int. 2016;37(1):viii–xvi. [PubMed] [Google Scholar]

13. Larson CM, Almekinders LC, Taft TN, Garrett WE. Intramedullary spiral fixation of Jones fractures. Analysis of failure. Am J Sports Med. 2002;thirty(i):55–60. [PubMed] [Google Scholar]

14. Lawrence SJ, Botte MJ. Jones' fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993;fourteen(vi):358–365. [PubMed] [Google Scholar]

fifteen. Lee Thousand, Park Y, Jegal H, Kim K, Young Thousand, Kim J. Factors associated with recurrent fifth metatarsal stress fracture. Pes Ankle Int. 2013;34(12):1645–1653. [PubMed] [Google Scholar]

16. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Show of validity for the Foot and Ankle Ability Mensurate (FAAM). Foot Talocrural joint Int. 2005;26(11):968–983. [PubMed] [Google Scholar]

17. Mologne TS, Lundeen JM, Clapper MF, O'Brien TJ. Early screw fixation versus casting in the treatment of astute Jones fractures. Am J Sports Med. 2005;33(7):970–975. [PubMed] [Google Scholar]

18. Murawski CD, Kennedy JG. Percutaneous internal fixation of proximal fifth metatarsal Jones fractures (zones II and Iii) with Charlotte Carolina screw and bone marrow aspirate concentrate. Am J Sports Med. 2011;39(6):1295–1301. [PubMed] [Google Scholar]

nineteen. Nagao M, Saita Y, Kameda S, et al. Headless compression screw fixation of Jones fractures: an outcomes study in Japanese athletes. Am J Sports Med. 2012;40(11):2578–2582. [PubMed] [Google Scholar]

20. Nunley JA, Glisson RR. A new option for intramedullary fixation of Jones fractures: the Charlotte Carolina Jones Fracture Organization. Foot Ankle Int. 2008;29(12):1216–1221. [PubMed] [Google Scholar]

21. Orr JD, Glisson RR, Nunley JA. Jones fracture fixation: a biomechanical comparing of partially threaded screws versus tapered variable pitch screws. Am J Sports Med. 2012;40(3):691–698. [PubMed] [Google Scholar]

22. Petrisor BA, Ekrol I, Court-Chocolate-brown C. The epidemiology of metatarsal fractures. Foot Talocrural joint Int. 2006;27(iii):172–174. [PubMed] [Google Scholar]

23. Roche AJ, Calder JDF. Handling and return to sport post-obit a Jones fracture of the fifth metatarsal: a systematic review. Human knee Surg Sports Traumatol Arthrosc. 2013;21(6):1307–1315. [PubMed] [Google Scholar]

24. Shereff MJ, Yang QM, Kummer FJ, Frey CC, Greenidge N. Vascular anatomy of the fifth metatarsal. Foot Talocrural joint. 1991;11(6):350–353. [PubMed] [Google Scholar]

25. Sides SD, Fetter NL, Glisson R, Nunley JA. Bending stiffness and pull-out strength of tapered, variable pitch screws, and half-dozen.5-mm cancellous screws in acute Jones fractures. Human foot Talocrural joint Int. 2006;27(10):821–825. [PubMed] [Google Scholar]

26. Smith TO, Clark A, Hing CB. Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the electric current bear witness-base. Foot Talocrural joint Surg. 2011;17(four):300–307. [PubMed] [Google Scholar]

27. Torg JS, Balduini FC, Zelko RR. Fractures of the base of the fifth metatarsal distal to the tuberosity: classification and guidelines for not-surgical and surgical management. J Bone Joint Surg Am. 1984;66(29):209–214. [PubMed] [Google Scholar]

28. Wright RW, Fischer DA, Shively RA, Heidt RS, Nuber GW. Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med. 2000;28(5):732–736. [PubMed] [Google Scholar]

Articles from Orthopaedic Periodical of Sports Medicine are provided hither courtesy of SAGE Publications

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219008/