Biologic status, screw fit and position contribute to failed fifth metatarsal fracture treatment in athletes
TORONTO — Team physicians who treat high-level athletes with fifth metatarsal fractures, ones that are in zone 2 at the proximal extent of the fifth metatarsal and known as Jones fractures, should focus on ways to avoid failed treatment if they decide to surgically fix the fracture, a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting, said here.
“There could be a problem with nonunions and refractures ... so for that reason, our threshold to repair these in athletes — particularly high-level athletes — is low,” Kenneth Hunt, MD, of the University of Colorado, said.
“These typically don’t end careers,” he said.
Hunt discussed five factors that contribute to failed treatment of these factors, of which orthopedic surgeons should be aware.
“Screws to fix fractures should fit the canal,” Hunt said, noting a small, intramedullary screw diameter can be problematic and lead to a later failed treatment.
Problems associated with poor screw position are also associated with failed treatment, Hunt said.
“I want to get the threads past the site, but I don’t want to go any longer than that because I don’t want to risk displacing it,” he said.
“Foot posture is important,” according to Hunt. Cavovarus foot alignment should be avoided because it has been linked with a higher risk of refracture. Researchers of recent studies have found foot posture matters in these patients, he said.
Testosterone and vitamin D levels constitute an athlete’s biological status and these levels should be checked and optimized, Hunt said.
“Insufficient biology is something we are discovering more,” he said.
Hunt said it is important to check for and correct vitamin D levels because research has shown 55% of patients with Jones fractures have low vitamin D levels.
Lastly, he urged surgeons and trainers to avoid allowing patients to return to play too aggressively. When a high-level athlete returns to play too soon and healing is possibly not yet complete, it exposes the Jones fracture to excessive force, he said. – by Susan M. Rapp
Hunt K. Optimizing outcomes with the fifth metatarsal fracture in the high-level athlete. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.
Disclosure: Hunt reports no relevant financial disclosures.