title: Percutaneous internal fixation of proximal fifth metatarsal jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes.
abstract: BACKGROUND
  Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of nonspecific fixation hardware and poor blood supply.
  
  
  OBJECTIVE
  To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures.
  
  
  RESULTS
  The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P < .01). The mean physical component of the SF-12 score significantly improved, from 25.69 points preoperatively (range, 6-39) to 54.62 at final follow-up (range, 32-62; P < .01). The mean mental component of the SF-12 score also significantly improved, from 28.20 points preoperatively (range, 14-45) to 58.41 at final follow-up (range, 36-67; P < .01). The mean time to fracture healing on standard radiographs was 5 weeks after surgery (range, 4-24). Two patients did not return to their previous levels of sporting activity. One patient experienced a delayed union, and 1 healed but later refractured.
  
  
  CONCLUSIONS
  Percutaneous internal fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA. murawskic@hss.edu
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D016026:Bone Marrow Transplantation; D001863:Bone Screws; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D014182:Transplantation, Autologous; D055815:Young Adult