SLR - September 2010 - Ashma S. Davidson
Reference: David A. Porter, MD, PhD; et al. Foot & Ankle International/Vol.30, No. 1/January 2009; 27-33.
Scientific Literature Reviews
Reviewed by: Ashma S. Davidson
Residency Program: UH Richmond Medical Center/OCPM
Podiatric Relevance:
This study examines the use of two different forms of internal fixation when the podiatric surgeon is faced with the Jones fifth metatarsal fracture.
Methods:
Twenty Jones-type fifth metatarsal fractures in athletic patients were treated with a 5.5mm screw. Of these 20 fractures, six were acute fractures, ten were delayed unions, and four were nonunions. The mean height of the study population was 72.9 inches and the mean weight was 202.4 pounds. The comparison group consisted of 24 fracture in 23 athletes t reated with a 4.5mm screw. Of these 24 fractures, threewere acute fractures, ten were delayed unions, and 11 were nonunions. This group of athletes mean height was 72.4 inches and mean weight was 188.9 pounds.
The surgical technique was the same for both groups. A 3 to 4 cm incision was made proximal to the fifth metatarsal beginning at the base and extending proximally. The fifth metatarsal was approached inferior to the peroneus brevis tendon. The abductor digiti minimi quinti was incised to expose the base of the metatarsal. Proper technique was then continued to insert both screws for their individual study group. Postoperative rehabilitation for both study groups included range of motion exercises, cold compression therapy, a removable walking boot, and walking with crutches.
Results:
Participants in the 5.5 mm study group were followed for an average of 16.5 months and those in the 4.5 mm study were followed for an averag of 19.8 months. Average radiographic healing was 96.7% and all fractures healed clinically. There was a higher rate of screw bending in the 4.5 mm group, but a higher rate of bone penetration in the 5.5 mm group. These rates were not statistically significant however. Three patients in the 5.5 mm group suffered re-injury shortly after the surgery. In the 4.5 mm comparison group there were no refractures, but there were 3 bent screws. There were no differences found in the screws.
Conclusions:
The authors concluded that a 5.5 mm stainless steel cannulated screw is effective for fixation of a Jones fracture in athletes. No refractures, nor screw bending occurred with this larger diameter screw. However, one can expect a higher risk of bone penetration with this larger diameter screw. With the numbers available for this study, one cannot conclude that a 5.5 mm screw is more effective when compared to a 4.5 mm screw for the fixation of a fifth metatarsal Jones fracture.