title: Closed intramedullary screw fixation for nonunion of fifth metatarsal Jones fracture.
abstract: BACKGROUND
  Nonunion following a proximal fifth metatarsal metaphyseal-diaphyseal or Jones fracture can cause considerable pain with high morbidity and loss of work. Treatment should aim for early union, thus allowing early return to activity. The present study evaluated the outcomes and the time required for union following closed intramedullary screw fixation for this condition.
  
  
  METHODS
  Between January 2005 to August 2009, 14 patients were diagnosed with nonunion following a Jones fracture. Mean age at surgery was 49 years. Mean duration from injury to surgery was 28 weeks. All nonunions were fixed with a single intramedullary screw inserted from the base of the fifth metatarsal without opening the nonunion site. Serial postoperative radiographs were evaluated to determine union. Time required for return to activity was determined. Outcome was assessed with help of pain scores. Mean followup was 27 months.
  
  
  RESULTS
  Union was achieved in all 14 patients with one delayed union. Mean time to union was 13.3 (range, 8 to 20) weeks. All patients were able to start unassisted full weightbearing without pain at mean 10.2 weeks. Overall pain score improved from a preoperative mean of 5.4 to postoperative mean of 1.0. Complications included one deep infection, one delayed wound healing and one sural neuroma.
  
  
  CONCLUSIONS
  Closed intramedullary screw fixation achieved an excellent union rate when used in the treatment of nonunion of a Jones fractures.
authors: Orthopaedic Associates of Michigan, Orthopaedics, 1111 Leffingwell Ave NE, Grand Rapids, MI 49525, USA.
authors: Rohan A
authors: RA
authors: Habbu
authors: Robert S
authors: RS
authors: Marsh
authors: John G
authors: JG
authors: Anderson
authors: Donald R
authors: DR
authors: Bohay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D010147:Pain Measurement; D016474:Weight-Bearing