Early screw fixation versus casting in the treatment of acute Jones fractures.
BACKGROUND
There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures.


OBJECTIVE
Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment.


METHODS
Randomized controlled clinical trial; Level of evidence, 1.


METHODS
Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient.


RESULTS
Mean follow-up was 25.3 months (range, 15-42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with P < 001.


CONCLUSIONS
There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.
Mologne
Timothy S
TS
Sports Medicine Center, 277 Altenhofen Drive, Appleton, WI 54913, USA. drmologne@thesportsmedcenter.com
Lundeen
Jeffrey M
JM
Clapper
Mark F
MF
O'Brien
Thomas J
TJ
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D002370:Casts, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D017211:Treatment Failure