Jones Fracture ORIF

Edited by Kenneth Hunt, MD

 

Indications

Due to a number of mechanical and biologic factors, patients with a base of 5th metatarsal stress fracture (Jones fractures) are at risk of inadequate healing and refracture of the bone in the same location. Patients with this injury where it does not adequately heal, or the fracture recurs, may benefit from stabilization of the fracture with a screw placed through the bone. Some highly active and athletic patients benefit from screw fixation after the acute injury to reduce accelerate healing and rehabilitation and reduce the risk of refracture.

Procedure

The surgical procedure involves placing an appropriate-sized screw, starting at the tip of the base of the 5th metatarsal, and placing the screw within the bone across the fracture site. This is done by making a small incision near the base of the 5th metatarsal. The tip of the 5th metatarsal is identified on x-ray (fluoroscopy). A drill is then used to enter the canal of the 5th metatarsal, and then placed across the fracture site. This is done under fluoroscopy to ensure the screw is correctly positioned. A screw with an appropriate diameter and length is chosen, the diameter is typically 4.5-6.5 mm., and the screw is then positioned across the fracture site so as to stabilizes the bone and compresses the fracture to promote healing of the fracture.

Recovery

Recovery from the surgery involves not only the recovery from the actual surgery, but more importantly, time to allow the 5th metatarsal stress fracture (Jones fracture) to heal (usually six to eight weeks). The sutures in the small incision will need to be removed after 10 to 14 days.

Potential Complications

General Complications

This surgery has the potential for the usual array of postsurgical complications including:

• Infection
• Wound healing problems
• Deep Vein Thrombosis (DVT)
• Pulmonary Embolism (PE)
• Nerve injury

Specific Complications

Specific problems or complications related to 5th metatarsal fracture screw fixation of Jones-type fractures of the 5th metatarsal include:

• Continued 5th metatarsal non-union or refracture. The screw is designed to stabilize the bone and make it more likely to heal. However, it does not affect the underlying foot shape and as such this area may still be getting excessive load. This may result in either failure to heal the stress fracture or recurrent stress fracture after it has healed. There is usually a mechanical or biologic reason for this complication that a doctor will investigate. For example, patients with very high arches (i.e., cavus foot), and with certain hormonal deficiencies, like vitamin D or thyroid, are at risk of non-union or refracture.
• Failure of the Hardware. If the stress fracture recurs and the bone breaks, the screw is at risk of breaking as well. This occurs in the same way that a paper clip breaks by being wiggled back and forth.
• Prominent Hardware. If the screw head is large and prominent which it often is, some discomfort associated with the screw head may be present.
• Further fracturing of the 5th metatarsal. At the time of surgery, or later after the patient has begun weight-bearing, further fracturing of the 5th metatarsal may occur. During surgery, the drill may go through the other side of the metatarsal bone. Although this is sometimes done on purpose by the surgeon in order to get better fixation, it can also weaken the bone and, in a small percentage of cases, may lead to another fracture in the bone at a different location.

 

 

Edited February 1, 2017

mf/12.10.18