Abstract
Category:
Lesser Toes; Midfoot/Forefoot
Introduction/Purpose:
The Jones fracture of the proximal fifth metatarsal metadiaphysis is predisposed to delayed union and nonunion due to a tenuous blood supply. Surgical fixation followed by delayed weightbearing is commonly recommended, though the optimal period of nonweightbearing after surgery is not well defined. In response to more recent literature and in an effort to facilitate functional recovery, the trend in our practice has begun to shift toward earlier weightbearing for all patients after Jones fracture fixation. The purpose of this study is to investigate the effect of earlier weightbearing after surgical fixation of Jones fractures.
Methods:
All Jones fractures treated with an intramedullary (IM) screw in a large, urban practice from 2012-2018 were identified. We excluded fractures that were chronic in nature and patients with underlying metabolic disease. We defined a delayed union as longer than 12.5 weeks based on published data. Time to weightbearing and early weightbearing (within 1 week of surgery) were investigated as risk factors for delayed union using logistic regression and Fisher exact tests, respectively. The relationship between time to weightbearing and time to union was assessed with Spearman correlation. Additional variables were explored in bivariate analysis: time to surgery from initial presentation; age, sex, chronicity, tobacco use, weight, BMI, screw size; preoperative NSAID use, and postoperative VTE prophylaxis. Multivariate regression analyses were then performed to identify variables independently predictive of delayed union.
Results:
Forty-one cases were included (17 males, 24 females), all treated with IM fixation. Median age in the sample was 45 years ( IQR, 32-62 years). Overall mean time to union was 10.9 +- 7.0 weeks (range, 4.9-41.4 weeks). There were nine (22.0%) delayed unions. Earlier weightbearing was not significantly predictive of delayed union (OR 1.02; 95% CI, 0.99-1.05; P = 0.211), and the incidence of nonunion was not significantly different between early and delayed weightbearing groups (OR, 1.20; 95% CI, 0.02- 17.54; P > .999). In bivariate analysis, increasing age was associated with increasing risk of delayed union (OR, 1.06; 95% CI, 1.01- 1.12; P = 0.031), and was correlated with time to union (ρ = 0.327, P = 0.037). Mutivariate analaysis demonstarted no significant variables.
Conclusion:
Our results suggest that earlier weightbearing after internal fixation of Jones fractures is not a risk factor for delayed union and does not significantly alter healing time. These findings are consistent with previously published data, but go further by assessing the effects of time to weightbearing in continuous regression models.