Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2023; 90(1):53-58 | DOI: 10.55095/achot2023/008

5^th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?Original papers

J. DEMEL^1,2,10,*, L. PLANKA³, R. STICHHAUER⁴, A. VRTKOVA^5,6, G. BAJOR^7,8, M. HAVLICEK⁹, L. PLEVA^1,2

¹ Department of Trauma Surgery, University Hospital Ostrava, Czech Republic

² Department of Disaster Medicine, Faculty of Medicine, University of Ostrava, Czech Republic

³ Department of Pediatric Surgery, Orthopedics and Trauma Surgery, University Hospital Brno Czech Republic

⁴ Department of Pediatric Surgery and Trauma Surgery, University Hospital Hradec Králové Czech Republic

⁵ Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic

⁶ University Hospital Ostrava, Department of the Deputy Director for Science, Research and Education, Ostrava, Czech Republic

⁷ Department of Human Anatomy, Faculty of Medical Science in Katowice, Medical University in Katowice, Katowice, Poland

⁸ Department of Anatomy, Faculty of Medicine, University of Ostrava, Czech Republic

⁹ MEDIN, a.s., Nové Město na Moravě, Czech Republic

¹⁰ Faculty of Medicine, Masaryk University, Brno, Czech Republic

PURPOSE OF THE STUDY:
Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department.

MATERIAL AND METHODS:
Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again.

RESULTS:
Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week.

DISCUSSION:
Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life.

CONCLUSIONS:
Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment.

Keywords: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment

Published: February 15, 2023  Show citation