New technique may help prevent repeat Jones fractures
A metal plate might be the cure for a common foot injury seen in athletes and people on their feet all day, according to new research conducted at Houston Methodist.
In a paper published online February 21 by The American Journal of Sports Medicine, researchers led by Kevin Varner, M.D., a Houston Methodist foot and ankle orthopedic surgeon, found that a metal plate may provide a more stable repair for Jones fractures.
The fifth metatarsal is the bone that connects the small toe to the ankle. A Jones fracture occurs near where the fifth metatarsal connects to the ankle. These fractures are often caused by repetitive stresses during any weight bearing activity and that’s why many athletes are vulnerable to this injury. Kevin Durant, forward for the Golden State Warriors and MVP of the 2017 NBA Finals, missed the start of the 2014-15 NBA season due to a Jones fracture, and NFL stars Julio Jones, Dez Bryant, Greg Olsen, and Michael Crabtree have faced the same injury during their careers.
The current standard of care is to implant a screw in to the canal of the fifth metatarsal bone to draw the fractured ends back together. However, up to 30 percent of Jones fractures repaired with the screw can reoccur.
“Plates are commonly used to help repair fractured bones, but orthopedic surgeons haven’t been using plates to repair Jones fractures,” Varner said. “After seeing several Jones refractures in patients who had been treated with the screw, I wanted to find a better repair method and thought the well-known and proven technique of plating might be that solution.”
To test the durability of the screw versus the plate, Varner and a team of researchers divided 12 pairs of foot models in to two groups, with one foot from each pair assigned to receive the traditional screw repair and the other receiving the plate repair. After creating a Jones fracture and repairing it with either a screw or a plate, the fifth metatarsal was removed from the foot model.
Each bone went through load bearing testing in which force was increased every 10 cycles until failure occurred. This process recreated the stresses placed on the fifth metatarsal that are seen in the normal foot motions of walking and running.
During these tests, researchers noted that the failures occurred where the bone connected with the implant – either the screw was pulled out of the bone or the bone pulled away from the plate. On average, the screw group failed at 37.3 cycles compared to 63.9 cycles for the plate. The plate withstood an average of 35.8 pounds of force, while the screw failed around 21.7 pounds of force.
“While further research is needed, these early results tell me repairing a Jones fracture with a plate is a safe and more effective technique than the currently accepted method,” Varner said. “A second Jones fracture can be very distressing for patients. They will miss work to undergo a second surgery, and increased time out of the game can derail an athlete’s season or career. I’m confident the plating technique for Jones fractures will continue to prove beneficial for our patients.”
Houston Methodist serves as the official health care provider for the Houston Texans, Houston Astros, Houston Dynamo, Houston Dash, Rice Athletics, RodeoHouston and Houston Ballet.
For more information: A Biomechanical Comparison of Fifth Metatarsal Jones Fracture Fixation Methods. The American Journal of Sports Medicine. Online February 21, 2018. N. L. Duplantier, R. J. Mitchell, S. Zambrano, A. C. Stone, D. A. Delgado, B. S. Lambert, M. R. Moreno, J. D. Harris, P. C. McCulloch, D. M. Lintner, K. E. Varner. DOI: 10.1177/0363546517753376.