title: Failed Surgical Management of Acute Proximal Fifth Metatarsal (Jones) Fractures: A Retrospective Case Series and Literature Review.
abstract: Nonunion, delayed union, and refracture after operative treatment of acute proximal fifth metatarsal fractures in athletes is uncommon. This study was a failure analysis of operatively managed acute proximal fifth metatarsal fractures in healthy athletes. We identified 149 patients who underwent operative treatment for fifth metatarsal fractures. Inclusion criteria isolated skeletally mature, athletic patients under the age of 40 with a minimum of 1-year follow-up. Patients were excluded with tuberosity fractures, fractures distal to the proximal metaphyseal-diaphyseal region of the fifth metatarsal, multiple fractures or operative procedures, fractures initially treated conservatively, and medical comorbidities/risk factors for nonunion. Fifty-five patients met the inclusion/exclusion criteria. Four (7.3%) patients required a secondary operative procedure due to refracture. The average time to refracture was 8 months. All refractures were associated with bent screws and occurred in male patients who participated in professional basketball, professional volleyball, and college football. The average time for release to progressive weight-bearing was 6 weeks. Three patients were revised to a bigger size screw and went on to union. One patient was revised to the same-sized screw and required a second revision surgery for nonunion. All failures were refractures in competitive athletes who were initially treated with small diameter solid or cannulated stainless steel screws. The failures were not associated with early postoperative weight-bearing protocol. Maximizing initial fixation stiffness may decrease the late failure rate in competitive athletes. More clinical studies are needed to better understand risk factors for failure after screw fixation in the competitive, athletic population.
  
  
  METHODS
  Prognostic, Level IV: Case series.
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP).
authors.forename: Jaymes D
authors.initials: JD
authors.lastname: Granata
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP).
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Berlet
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP) ofacresearch@orthofootankle.com.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Philbin
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP).
authors.forename: Grant
authors.initials: G
authors.lastname: Jones
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP).
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
authors.affiliation: Desert Orthopaedic Center, Las Vegas, Nevada (JDG)Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, TMP)Department of Orthopaedics, The OSU Sports Medicine Center, The Ohio State University Medical Center, Columbus, Ohio (GJ)Department of Orthopaedics and The OSU Athletic Department, Columbus, Ohio (CCK)Suburban Orthopaedics, Bartlett, Illinois (KSP).
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000601:surgery; D001863:Bone Screws / Q000009:adverse effects; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
keywords: Jones fracture; delayed union; nonunion; proximal fifth metatarsal; revision surgery