SLR - February 2023 - Arwa Akram, DPM
Title: Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysisReference: Attia AK, Taha T, Kong G, Alhammoud A, Mahmoud K, Myerson M. Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2021;49(12):3422-3436. doi:10.1177/0363546521990020
Level of Evidence: Level II
Reviewed By: Arwa Akram, DPM
Residency Program: Ascension St. Vincent Hospital, Indianapolis, IN
Podiatric Relevance: Proximal fifth metatarsal fractures are common in the general population, However, certain sports that involve repetitive jumping place increased forces on the forefoot, leading to a higher risk of fractures and refractures. Complete and expedited healing is a necessity in the athletic population to allow patients to return to sports. The authors of this article performed an updated systematic review and meta-analysis providing the evidence to facilitate the decision-making process for surgeons and coaches. The authors provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative. They also explored the union rate and time to union as well as the rate of complications.
Methods: Following the PRISMA guidelines, 2 independent team members searched several databases to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. They identified 168 studies, of which 22 studies were eligible for meta-analysis with a total of 646 Jones fractures.The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures.
Results: The overall RTP rate was 98.4%. The RTP rate with IM screw fixation only was 98.8% with other surgical fixation methods was 98.4% and with nonoperative management was 71.6%. The RTP rate according to type of sport was 99.0%in football, 91.1% in basketball, and 96.6% in soccer. There was a significant difference in the time to RTP. The RTP was 9.6 weeks in the IM screw fixation group and 13.1 weeks in the nonoperative group. The time to union with IM screw fixation was 8.2 weeks. With nonoperative treatment it was 13.7 weeks. The rate of delayed union was 2.5% and the overall refracture rate was 10.2%.
Conclusions: IM screw fixation is a simple and reliable treatment of choice in most individuals undergoing surgical management of Jones fracture. Certain anatomical abnormalities can have an increase riks of Jones fractures and re-fractures, such as metatarsus adductus and long, straight, and narrow fifth metatarsals. Custom footwear and orthoses to offload the lateral column in susceptible players are recommended. The article also mentions optimal screw size to be 5.5 mm in diameter and shorter than 52 mm in most patients. Screw removal and screw head irritation is a common complication which can be decreased by countersinking the screw head or using headless screws.