title: Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA.
abstract: BACKGROUND
  Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes.
  
  
  METHODS
  The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles.
  
  
  RESULTS
  Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid.
  
  
  CONCLUSIONS
  This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Malley
authors.affiliation: Hospital for Special Surgery, New York, NY, USA desandisb@hss.edu.
authors.forename: Bridget
authors.initials: B
authors.lastname: DeSandis
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Answorth
authors.initials: A
authors.lastname: Allen
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Levitsky
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Quinn
authors.initials: Q
authors.lastname: O'Malley
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Riley
authors.initials: R
authors.lastname: Williams
mesh_terms: D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000601:surgery; D001490:Basketball / Q000293:injuries*; D001835:Body Weight; D001863:Bone Screws; D016025:Bone Transplantation; D018409:Foot Injuries / Q000534:rehabilitation / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Jones fracture; athletes; basketball; bone graft; fifth metatarsal; fixation; operative treatment; refracture