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Athletic Training Services Team
Texas Medical Center/San Jacinto
Bene Barrera ATC, LAT
Jeff Collins, LAT
Jace Duke, ATC, LAT
Emery Hill, ATC, LAT
Terry King, LAT
Michelle Leget, ATC, LAT
Ha Nguyen ATC, LAT
Caitlyn Prescott ATC, LAT
Scott Tidwell, LAT
Jerry Meins, ATC, LAT
Stephen Melancon, ATC, LAT
Brandon Roberts, ATC, LAT
Bill Wissen, ATC, LAT
Richard Gregoire, ATC, LAT
Layne Schramm, ATC, LAT
Dwight Adsit, ATC, LAT
Paula Douglas, ATC, LAT
Keith Jahn, ATC, LAT
Mike Pace, ATC, LAT
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Treatment of Jones Fracture
The classic proximal 5th metatarsal fracture, or Jones Fracture, is common in sports that require pivoting, cutting and jumping. A Jones Fracture is a difficult injury to treat due to avascularity of the proximal 5th metatarsal. The chance of delayed union, or non-union of a 5th metatarsal fracture increases if the fracture site is not immobilized, and the patient is weight-bearing. The presence of the peroneal tendon insertion at or near the fracture site compounds the ability to immobilize the fracture site.
Several fracture classifications apply to the fifth metatarsal. Simple classification for fractures of the proximal end of the 5th metatarsal, are (1) those of the tuberosity and (2) those of the proximal metatarsal within 1.5 cm of the tuberosity. The Torg classification is used for fractures within 1.5 cm of the metatarsal tuberosity. Type I includes fractures with sharp margins and no widening, sclerosis, periosteal reaction, or cortical hypertrophy. Type II includes fractures with widening, periosteal reaction, sclerosis, or both. Type III fractures involve widening, periosteal reaction, complete sclerosis at the fracture line, or both.
Treatment of the Jones Fracture can be difficult. Acute, non-displaced, Zone I and Zone II fracture can be treated non-operatively. However, the patient must be immobilized and non-weight bearing for 6-8 weeks. As many as 34% of acute Jones Fractures become sclerotic at the fracture site and become a delayed union, or non-union fracture. The pull of the peroneal tendon can widen the fracture site and the patient can experience sclerosis at the fracture site.
Surgical treatment of the Jones Fracture involves insertion of a large cancellous bone screw. Diameter of the screw is determined by the width of the bone canal. A long screw is recommended to create compression at the fracture site to promote primary bone healing. Autologous bone grafting is suggested to augment healing at the fracture sight. Complications of surgical fixation include; refracture, breakage of the screw, and missing the medullary canal. Postoperatively, the patient must remain non-weight bearing for a period of time until healing is evidenced on X-ray, followed by protected weight bearing until complete healing is evidenced.
Follow-up X-rays are the key to return-to-play decisions. There must be clear evidence on post-operative X-ray that bone union has occurred. The literature shows that early return to sport prior to complete radiographic union is predictive of failure. Even though intramedullary screw fixation offers advantages over nonoperative treatment, a significant risk of postoperative complications exist.
The Jones Fracture can be a difficult condition to treat. Athletes with Zone I and Zone II fractures might consider surgical stabilization for early return to activity. Due to the overwhelming number of complications with non-operative treatment of the Jones Fracture, results of operative treatment seem to enhance return-to-play. Athletes without complication return to activity at a mean of 6.8 weeks vs. 9 weeks for those with complication.
CONCUSSIONS: What Every Athlete and Athletic Trainer Should Know
Every year thousands of students both locally and nationally participate in some form of organized competition or play. Concussions can happen in any sport at any time. Recently the University Interscholastic League or UIL (the State of Texas’ governing body for interscholastic sports) mandated concussion training for all coaches and included cheer sponsors as part of a group that must attend a two-hour training session in order to coach in the public schools.
The medical staff and athletic trainers of Houston Methodist Orthopedics & Sports Medicine conducted many of these training sessions, as concussion awareness has become a priority for the health and safety of athletes at all levels.
Over the course of the year it is estimated that between 1.6 and 3.8 million concussions will be diagnosed in local emergency rooms nationwide (Langlois et al. 2006). Many more will go unreported. More than 50 percent of athletes polled stated that they did not report the symptoms to medical personnel (McCrea 2004).
The brain damage that occurs with concussion happens at the cell level. The injury causes a change in how the brain cells communicate and how they use glucose for fuel. These changes make the brain less efficient and more susceptible to injury. The brain heals and these changes go away, but it can take days to weeks.
It is important to remember a few key points about a concussion:
- MRI and CT scans are used to rule out major injuries to the skull and brain. They do not diagnose concussions. Often these scans are normal, but normal imaging does not mean that there is no concussion.
- Repeated trauma to an athlete with an unresolved concussion injury can be dangerous and sometimes fatal.
- Signs and symptoms can range from very vague to very obvious.
Signs and Symptoms of Concussion
|• Appears dazed||• Answers questions slowly|
|• Personality change||• Forgets events after injury|
|• Forgets events prior to injury||• Moves clumsily|
|• Loses consciousness||• Confused about play|
|• Headache||• Feeling sluggish|
|• Feeling foggy||• Cognitive changes|
|• Nausea||• Balance problems|
|• Double vision||• Photosensitivity|
Understand these are just some of the signs and symptoms of a concussion injury.
It is important to see sports medicine physicians who are highly trained and skilled at managing athletes with concussion – and certified in the ImPACT® Concussion Management System, which is considered by many to be the premier concussion management tool in the country.
Houston Methodist Orthopedic & Sports Medicine offers baseline ImPACT testing for a $5 charge. Open to all participants, ages 12 through high school, the test is administered by our licensed athletic trainers and best if done before the start of the athletic season. Contact our Athletic Trainer hotline at 713-441-8440 to schedule an appointment.
Visit www.methodistorthopedics.com to learn more about sports injuries. For a physician referral or appointment, call 713-790-3333.