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Surgical Management of Jones Fracture Nonunions

March 01, 2020

Contributors: Neil Bakshi, MD; James R Holmes, MD, FAAOS; Paul Talusan, MD, FAAOS; David Matthew Walton, MD; Benjamin Lindsey, MD

Keywords: Nonunion

Background Fractures of the base of the fifth metatarsal are common injuries managed by orthopaedic surgeons. Jones fractures are a subset of fifth metatarsal base fractures, occurring at the articulation between the fourth and fifth metatarsals. Because of a vascular watershed area, Jones fractures do not typically heal, leading to nonunion. Imaging studies of Jones fracture nonunions are notable for obliteration of the intramedullary canal from sclerosis. All symptomatic Jones fracture nonunions warrant surgical management in patients without medical comorbidities that preclude surgery. Intramedullary screw fixation for the management of fractures of the base of the fifth metatarsal is associated with a high rate of union. In patients with a Jones fracture nonunion, intramedullary screw fixation is associated with a 97% union rate. With precise technique, open reduction and internal fixation of Jones fracture nonunions with the use of an intramedullary screw and calcaneal autograft affords successful healing. Purpose This video provides an overview on Jones fractures and discusses the case presentation of a patient with a Jones fracture nonunion managed via open reduction and internal fixation with the use of an intramedullary screw and calcaneal autograft. Methods The video reviews the epidemiology, pathology, and diagnosis of Jones fractures, specifically nonunions, and discusses treatment options and indications for surgical management. The video reviews the case presentation of a patient with a Jones fracture nonunion who underwent intramedullary screw fixation with the use of supplemental calcaneal autograft. The postoperative rehabilitation protocol and outcomes after fixation of Jones fracture nonunions are then reviewed. Results After a technically successful surgery, the patient progressed through our standard Jones fracture postoperative rehabilitation protocol, which resulted in successful union of the fracture. Conclusion Open reduction and internal fixation with the use of an intramedullary screw and supplemental calcaneal autograft is a successful treatment option for the management of Jones fracture nonunions. Multiple studies have reported high rates of union with surgical fixation. Successful outcomes are based on precise surgical technique.

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