Rethinking Our Approach To Jones Fractures To Facilitate Shorter Post-Op Recovery
Currently, I am using a six-hole plate from the Synthes Mini Fragment Set (Synthes). However, there are numerous small plates from various companies that I am sure would serve this purpose effectively. Currently, we are in the process of designing a “Jones Fracture Kit” complete with reamers, harvest cylinders and a locking plate in an attempt to standardize the necessary equipment.
While it appears there are numerous steps to this technique, after a few cases, surgeons can execute it quite efficiently. In my practice, I have found that this technique clearly improves and accelerates the recovery from this fracture. To date, I have been employing this technique for roughly nine years and my partner (Richard Bouché, DPM) has used it for over five years. We have consistently seen osseous healing within four to five weeks. Originally, this technique was dedicated to those fractures that demonstrated sclerosis or presented with a prodrome of symptoms. However, as confidence in the technique evolved with excellent, predictable success in athletes, we are now recommending the procedure even in acute fractures devoid of sclerosis.
To be clear, it is not my assertion that one should address all Jones fractures in this manner. In fact, most foot surgeons have been content with the results utilizing intramedullary screw fixation. If something works in your hands, by all means, stick to your guns.
In my experience, the intermetatarsal screw fixation has been less than gratifying. Admittedly, most Jones fractures heal consistently with a well placed intermetatarsal screw. That said, the average time to union is well over seven weeks.8 This is not to mention some of the potential issues including: hardware irritation; plastic deformation; re-breakage after screw removal; and nerve entrapment with percutaneous screw fixation.5,9 Furthermore, what a luxury to be able to tell your active patients that you can honestly predict their return to activity will be two to three weeks earlier with this technique.
Currently, our Sports Medicine Clinic in Seattle is beginning a formal, prospective, clinical trial to test the assertions in this article in a more objective, scientific manner. Observation, time and experience will be the true judges of this new technique. That said, after having addressed the Jones fracture in this manner for the better part of a decade, I can honestly contend that it is a superior procedure. I would be surprised if future research contradicts this assertion.
Dr. Blahous is in private practice at the Sports Medicine Clinic in Seattle. He is a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is in private practice in Seal Beach, Ca.