Predictors of Malreduction in Zone II and III Fifth Metatarsal Fractures Fixed With an Intramedullary Screw

Background: Proper implant selection and placement is crucial during fixation of zone II and III fifth metatarsal fractures to avoid postoperative complications. This study examined the effects of screw parameters and placement on malreduction, delayed union, nonunion, and refracture rate. Methods: A retrospective review of zone II and proximal zone III fifth metatarsal fractures managed with intramedullary screw fixation was conducted. Comparisons were made between cortex distraction (gap) and ratios of screw length, diameter, and entry point. Further analysis was carried out between time to union and distraction in the lateral and plantar cortices. Results: The plantar and lateral gaps were both associated with the mean entry point ratio on the lateral and anteroposterior (AP) views (P < .001 for both views). No association between the plantar and lateral gaps and the screw diameter ratio (P = .393 for AP and P = .981 for lateral) or the screw length ratio (P = .966 for AP and P = .740 for lateral) was identified. The ratio of postoperative to preoperative apex height on AP and lateral views was correlated with the presence of lateral and plantar fracture gaps (P < .001). The presence of a plantar gap was associated with increased time to union (P = .022). A majority of fractures showed radiographic union at 12 weeks (38/43). Only 5 of 38 patients had delayed union. There were no refractures or nonunions as per available records. Conclusion: Plantar or lateral fracture site distraction (gap) was not influenced by screw diameter ratio or screw length ratio. The entry point ratio had a significant effect on plantar and lateral gaps on postoperative radiographs, with lateral and inferior placement leading to fracture site distraction. Patients with a plantar gap did have an increased risk of delayed union. The results of this study emphasize the significance of the entry point when managing zone II and III fifth metatarsal base fractures. Level of Evidence: Level IV, case series.

[1]  M. Drakos,et al.  Optimal Starting Point for Fifth Metatarsal Zone II Fractures: A Cadaveric Study , 2017, Foot & ankle international.

[2]  R. Buckley,et al.  Fifth metatarsal fractures and current treatment , 2016, World journal of orthopedics.

[3]  M. Drakos,et al.  Multiplanar CT Analysis of Fifth Metatarsal Morphology , 2016, Foot & ankle international.

[4]  E. Sheehan,et al.  Jones fracture of the fifth metatarsal: Is operative intervention justified? A systematic review of the literature and meta-analysis of results. , 2015, Foot.

[5]  Christopher F. Hyer,et al.  Screw fixation diameter for fifth metatarsal jones fracture: a cadaveric study. , 2015, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[6]  B. Ho,et al.  Radiographic Study of the Fifth Metatarsal for Optimal Intramedullary Screw Fixation of Jones Fracture , 2015, Foot & ankle international.

[7]  Robert B. Anderson,et al.  A Clinical and Radiographic Comparison of Two Hardware Systems Used to Treat Jones Fracture of the Fifth Metatarsal , 2013, Foot & ankle international.

[8]  J. Calder,et al.  Fifth metatarsal fractures in the athlete: evidence for management. , 2013, Foot and ankle clinics.

[9]  J. Ekstrand,et al.  Fifth metatarsal fractures among male professional footballers: a potential career-ending disease , 2013, British Journal of Sports Medicine.

[10]  Young Uk Park,et al.  Prognostic Classification of Fifth Metatarsal Stress Fracture Using Plantar Gap , 2013, Foot & ankle international.

[11]  J. Calder,et al.  Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[12]  A. Kothari,et al.  The Jones Fracture Classification, Management, Outcome, and Complications , 2012, Foot & ankle specialist.

[13]  A. Clark,et al.  Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base. , 2011, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.

[14]  Young Uk Park,et al.  The Plantar Gap , 2011, The American journal of sports medicine.

[15]  V. Mahajan,et al.  Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation , 2011, Clinics in orthopedic surgery.

[16]  C. Murawski,et al.  Percutaneous Internal Fixation of Proximal Fifth Metatarsal Jones Fractures (Zones II and III) With Charlotte Carolina Screw and Bone Marrow Aspirate Concentrate , 2011, The American journal of sports medicine.

[17]  G. Adhikari,et al.  Comparative Study of Early Screw Fixation Versus Cast Application on the Treatment of Acute Jones Fracture , 2010 .

[18]  Bryan D. Den Hartog.  Fracture of the proximal fifth metatarsal. , 2009 .

[19]  D. Porter,et al.  Comparison of 4.5- and 5.5-mm Cannulated Stainless Steel Screws for Fifth Metatarsal Jones Fracture Fixation , 2009, Foot & ankle international.

[20]  B. D. Den Hartog.  Fracture of the proximal fifth metatarsal. , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[21]  S. Raikin,et al.  The Association of a Varus Hindfoot and Fracture of the Fifth Metatarsal Metaphyseal-Diaphyseal Junction , 2008, The American journal of sports medicine.

[22]  T. J. O'brien,et al.  Early Screw Fixation versus Casting in the Treatment of Acute Jones Fractures , 2005, The American journal of sports medicine.

[23]  D. Porter,et al.  Fifth Metatarsal Jones Fracture Fixation with a 4.5-mm Cannulated Stainless Steel Screw in the Competitive and Recreational Athlete , 2005, The American journal of sports medicine.

[24]  J. Nunley.  Jones Fracture Technique , 2002 .

[25]  J. Nunley,et al.  Intramedullary Screw Fixation of Jones Fractures , 2001, Foot & ankle international.

[26]  R. Wright,et al.  Refracture of Proximal Fifth Metatarsal (Jones) Fracture After Intramedullary Screw Fixation in Athletes , 2000, The American journal of sports medicine.

[27]  Jike Lu,et al.  Anatomical and Radiological Considerations of the Fifth Metatarsal Bone , 2000, Foot & ankle international.

[28]  D. C. Wnorowski,et al.  Intramedullary Screw Fixation of Jones Fractures: A Biomechanical Study , 1999, Foot & ankle international.

[29]  M. Fernández Fairén,et al.  Fractures of the fifth metatarsal in basketball players , 1999, Knee Surgery, Sports Traumatology, Arthroscopy.

[30]  J. Torg,et al.  Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture , 1996 .

[31]  O'Brien Tj,et al.  Fractures of the fifth metatarsal. Analysis of a fracture registry. , 1995 .

[32]  Dameron.  Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. , 1995, The Journal of the American Academy of Orthopaedic Surgeons.

[33]  I. Redlund‐Johnell,et al.  Jones fracture. Surgical versus nonsurgical treatment. , 1994, Clinical orthopaedics and related research.

[34]  A. Agarwal.  Jones' fracture. , 1993, Texas medicine.

[35]  T. Brower,et al.  The Jones fracture revisited. , 1978, The Journal of bone and joint surgery. American volume.