AJSM Click here for details!
HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Sign In to gain access to subscriptions and/or personal tools.
First published on April 28, 2008, doi:10.1177/0363546508314401
This version was published on July 1, 2008
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
36/7/1367    most recent
0363546508314401v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Google Scholar
Right arrow Articles by Raikin, S. M.
Right arrow Articles by Ratigan, B.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Raikin, S. M.
Right arrow Articles by Ratigan, B.
Related Collections
Right arrow Fracture
The American Journal of Sports Medicine 36:1367-1372 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

The Association of a Varus Hindfoot and Fracture of the Fifth Metatarsal Metaphyseal-Diaphyseal Junction

The Jones Fracture

Steven M. Raikin, MD{dagger},*, Nicholas Slenker, MD{ddagger} and Brian Ratigan, MD{ddagger}

From the {dagger} Rothman Institute, Philadelphia, Pennsylvania, and {ddagger} Jefferson Medical College, Philadelphia, Pennsylvania

* Address correspondence to Steven M. Raikin, MD, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107 (e-mail: Steven.raikin{at}rothmaninstitute.com).

Background: Fractures to the fifth metatarsal metaphyseal-diaphyseal junction (Jones fracture) have high nonunion rates. Surgical intramedullary screw fixations have excellent results but a high refracture rate. This has been associated with inadequate screw size and too early return to activity.

Hypothesis: Varus hindfoot alignment overloads the lateral column of the foot and acts as a predisposing factor to the development of and failure of treatment of Jones fractures.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-one primary Jones fractures (20 patients) treated surgically with a 4.5-mm cannulated screw were retrospectively reviewed. Detailed clinical and radiographic data and outcomes were recorded, including measurements of hindfoot alignment.

Results: A 100% union rate with return to prior activity level and no refractures were found at a mean follow-up of 49 months. Clinical varus was present in 16 feet, whereas radiographic measurements revealed 18 of 21 hindfeet to be in varus. The mean calcaneal pitch angle was 28.5°, and the mean Meary angle was 13° convex upward. Patients with varus alignment were fitted postoperatively with lateral hindfoot and forefoot posted orthotic inserts to correct alignment.

Conclusion: The majority of patients sustaining Jones fractures have evidence of varus hindfoot alignment. This may be a predisposing factor to developing the fracture or refracture after fixation. Postoperative varus unloading (lateral hindfoot and forefoot posting) orthotic insert appears to be helpful in preventing reinjury or refracture of Jones fractures.

Key Words: Jones fracture • hindfoot varus • nonunion • lateral wedge • orthotic inserts






HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the American Orthopaedic Society for Sports Medicine.