injuryupdate
20-10-2004, 11:51 AM
Recent paper from the Am J Sports Med showing that the bigger the screw, the better, for surgical treatment of 5th metatarsal stress fractures (Jones' fractures). Smaller screws fail after many repetitions.
This version was published on October 1, 2004
The American Journal of Sports Medicine 32:1736-1742 (2004)
© 2004 American Orthopaedic Society for Sports Medicine
Cannulated Screw Fixation of Jones Fractures
A Clinical and Biomechanical Study
Keri Reese, MD*,,, Alan Litsky, MD, ScD,||, Christopher Kaeding, MD, Angela Pedroza and Nilesh Shah, MD¶
From the Ohio State University College of Medicine, Columbus, Ohio, Department of Orthopaedics, University of California, Irvine, California, Departments of Orthopaedics, || Biomedical Engineering, and ¶ Family Medicine, the Ohio State University, Columbus, Ohio
* Address correspondence to Keri Reese, MD, UC Irvine, Orange, CA 92868 (e-mail: kresse@uci.edu).
Background: Traditional nonsurgical treatment of Jones fractures has high rates of delayed union, nonunion, and refracture. Internal fixation has become the treatment of choice in athletes and active patients.
Purpose: The purpose of this study was (1) to review the short- and long-term clinical results of cannulated screw fixation of Jones fractures and (2) to perform a biomechanical evaluation of fatigue failure characteristics of several types of screws used in the fixation of Jones fractures.
Study Design: Retrospective case series and in vitro biomechanical study.
Methods: Ten male and 5 female patients with Jones fractures fixed with cannulated screws ranging from 4 mm to 6.5 mm in diameter were evaluated by chart review, review of radiographs, and telephone interview. Mean follow-up from surgery to phone survey was 34 months. Screws ranging in size from 2.7 mm to 7.3 mm, both cannulated and noncannulated, stainless steel and titanium, were tested in the laboratory by cyclic loading to 250 N up to a maximum of 200 000 cycles.
Results: Mean time to healing as shown on radiographs and by full activity after surgery were 7.3 and 7.9 weeks, respectively. All patients were able to return to their previous levels of activity. Screw fatigue data showed that the number of cycles to failure increased with increasing screw diameter. For 4-mm screws, mean number of cycles to failure was 4308 for cannulated titanium screws, 22 012 for cannulated stainless steel screws, and 44 523 for noncannulated stainless steel screws.
Conclusions: In our patients, cannulated screw fixation of Jones fractures was a procedure that was reliable, had low morbidity, and afforded athletes a quick return to activity.
Clinical Relevance: The laboratory study suggests that the largest screw possible should be used for surgical fixation of these fractures and that screws less than 4 mm in diameter should be used with caution.
Key Words: Jones fracture • screw fixation • metatarsal bones • fracture fixation intramedullary
This version was published on October 1, 2004
The American Journal of Sports Medicine 32:1736-1742 (2004)
© 2004 American Orthopaedic Society for Sports Medicine
Cannulated Screw Fixation of Jones Fractures
A Clinical and Biomechanical Study
Keri Reese, MD*,,, Alan Litsky, MD, ScD,||, Christopher Kaeding, MD, Angela Pedroza and Nilesh Shah, MD¶
From the Ohio State University College of Medicine, Columbus, Ohio, Department of Orthopaedics, University of California, Irvine, California, Departments of Orthopaedics, || Biomedical Engineering, and ¶ Family Medicine, the Ohio State University, Columbus, Ohio
* Address correspondence to Keri Reese, MD, UC Irvine, Orange, CA 92868 (e-mail: kresse@uci.edu).
Background: Traditional nonsurgical treatment of Jones fractures has high rates of delayed union, nonunion, and refracture. Internal fixation has become the treatment of choice in athletes and active patients.
Purpose: The purpose of this study was (1) to review the short- and long-term clinical results of cannulated screw fixation of Jones fractures and (2) to perform a biomechanical evaluation of fatigue failure characteristics of several types of screws used in the fixation of Jones fractures.
Study Design: Retrospective case series and in vitro biomechanical study.
Methods: Ten male and 5 female patients with Jones fractures fixed with cannulated screws ranging from 4 mm to 6.5 mm in diameter were evaluated by chart review, review of radiographs, and telephone interview. Mean follow-up from surgery to phone survey was 34 months. Screws ranging in size from 2.7 mm to 7.3 mm, both cannulated and noncannulated, stainless steel and titanium, were tested in the laboratory by cyclic loading to 250 N up to a maximum of 200 000 cycles.
Results: Mean time to healing as shown on radiographs and by full activity after surgery were 7.3 and 7.9 weeks, respectively. All patients were able to return to their previous levels of activity. Screw fatigue data showed that the number of cycles to failure increased with increasing screw diameter. For 4-mm screws, mean number of cycles to failure was 4308 for cannulated titanium screws, 22 012 for cannulated stainless steel screws, and 44 523 for noncannulated stainless steel screws.
Conclusions: In our patients, cannulated screw fixation of Jones fractures was a procedure that was reliable, had low morbidity, and afforded athletes a quick return to activity.
Clinical Relevance: The laboratory study suggests that the largest screw possible should be used for surgical fixation of these fractures and that screws less than 4 mm in diameter should be used with caution.
Key Words: Jones fracture • screw fixation • metatarsal bones • fracture fixation intramedullary