Treatment of Jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting.

BACKGROUND: Fractures of the proximal fifth metatarsal metaphysis (ie, the Jones fracture) can be problematic in the elite athlete because of a high incidence of nonunion and refracture with nonoperative treatment. Although these fractures are not common, athletes can suffer refracture or nonunion of a Jones fracture despite operative stabilization. This is often attributable to hardware of insufficient strength, aggressive postoperative rehabilitation, or biologic insufficiency at the fracture site.

PURPOSE: The authors review the results of revision intramedullary screw fixation with cancellous autologous bone grafting or bone-marrow aspirate combined with demineralized bone matrix after refracture or nonunion of Jones fractures in elite athletes.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: The authors retrospectively reviewed the clinical and radiographic outcomes and return to sport in 21 elite athletes undergoing treatment of Jones fracture refractures or nonunions. All patients underwent intramedullary screw fixation with autologous bone graft (12 patients), bone-marrow aspirate (BMA) + demineralized bone matrix (DBM) (8 patients), or no bone graft (1 patient).

RESULTS: All athletes were able to return to their previous level of athletic competition at an average of 12.3 weeks. All fractures showed clinical and radiographic evidence of compete cortical healing. Only 1 patient subsequently suffered a refracture.

CONCLUSION: The authors recommend revision fixation with a large, solid screw (5.5 mm or larger) and autologous bone grafting for symptomatic refractures and nonunions of the proximal fifth metatarsal in elite athletes. Additional investigation is needed to determine whether BMA combined with DBM is an effective substitute for cancellous autograft.