Want to Avoid Screwy Results from Toe Surgery? Give Sports a Rest
A fracture in the main bone of the little toe is called a Jones fracture. Technically speaking, this fracture involves the upper column of the fifth metatarsal bone. This type of fracture is difficult to treat, especially in athletes. Without surgery, these fractures may not heal properly, leading to more fractures and other problems.

With the athlete's long-term health in mind, doctors have started fixing Jones fractures with special screws. Overall, this method seems to be successful. But lately, some doctors have noticed more cases in which this treatment has failed. What causes treatment failure in athletes who have screw fixation for Jones fractures? And how can failures be avoided?

To answer these questions, researchers studied the records of 15 athletes who had screw fixation for Jones fractures. Six of the patients were division 1 college or professional athletes. The other patients were recreational athletes. Their average age was 22.

The patients had screw fixation of the broken bone using an imaging technique called fluoroscopy. In some cases, bone grafts were used. After surgery, patients wore walker boots or splints on the operated leg. They returned to full activity when their symptoms were gone and X-rays showed that the bones were healing together at the fracture site.

In six cases (40 percent), screw fixation did not work. Four of these patients fractured the foot again when they returned to full activity. In two of the failed cases, the bones simply did not heal together.

Patients whose treatment failed went back to full activity two weeks sooner than those who had good results (seven versus nine weeks total). Though all patients were without symptoms when they resumed activity, X-rays showed that only one in six patients whose treatment failed had complete bone healing by that point. In contrast, six out of seven patients who had good results showed complete bone healing when they went back to full activity.

Involvement in sports seemed to make a difference in how soon they returned to full activity and the success of treatment. Eighty-three percent of the failed cases were division 1 or professional athletes. Interestingly, elite athletes said their symptoms had gone away three weeks sooner than the other patients did. Researchers suspect that these athletes may have a higher tolerance for pain. They may also be more eager to get back into the game. Several of the elite athletes went back to full activity without getting a doctor's okay first.

Though the group studied was small, these results show that going back to vigorous activity too soon after screw fixation can lead to poor results. Surgical technique (use of bone grafts and size of screws) wasn't related to failure. However, a history of previous fractures was linked to treatment failure. The absence of symptoms during recovery does not prove the patient is ready for full activity. Patients need to wait until X-rays show complete healing before they return to full-impact activities after screw fixation for a Jones fracture.
Christopher M. Larson, MD, et al. Intramedullary Screw Fixation of Jones Fracture: Analysis of Failure. In The American Journal of Sports Medicine. January/February 2002. Vol. 30. No. 1. Pp. 55-60.