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Fanney L, Patel V, Tariq SM, Hong S, Davidson R, Nguyen JC. Pediatric foot fractures on radiographs: distribution and predictors of surgery. Emerg Radiol 2024; 31:341-348. [PMID: 38644451 DOI: 10.1007/s10140-024-02230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery. METHODS This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery. RESULTS 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3% and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%) of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95% CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95% CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95% CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95% CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors. CONCLUSION Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.
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Affiliation(s)
- Lewis Fanney
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Vandan Patel
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shahwar M Tariq
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Shijie Hong
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Richard Davidson
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Luo EJ, Anastasio AT, Stauffer T, Grant C, Wu CJ, Wu KA, Kaplan S, Lau BC. Jones Fracture in the National Football League. Sports (Basel) 2023; 12:7. [PMID: 38251281 PMCID: PMC10819528 DOI: 10.3390/sports12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Jones fracture, or proximal fifth metatarsal fracture, is a common injury in National Football League (NFL)-caliber athletes. Combine draft performance can greatly impact the long-term success of these athletes, and substantial emphasis has been placed on early return to play (RTP) and the minimization of post-operative complications after Jones fracture in these athletes. To date, no study has specifically described the treatment and outcomes of this injury specifically in NFL-caliber players, considering factors relevant to this unique population. Thus, the purpose of this review is to delve into Jones fracture in NFL-caliber athletes, evaluating the diagnostic, treatment, and RTP considerations. Methods: We searched Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCOhost) for the concept of Jones fractures in the NFL. Using the PRISMA guidelines, a team of three reviewers conducted abstract screenings, full-text screenings, and the extraction of studies describing Jones fractures specifically in the NFL. Results: Of the 1911 studies identified, 6 primary retrospective studies met the inclusion and exclusion criteria. The heterogeneity of the outcome reporting precluded a meta-analysis; thus, a qualitative review of manuscripts describing Jones fracture was carried out. Classification, diagnosis, and treatment considerations, RTP statistics and outcomes, and complications were discussed. Amongst the primary studies, there were 285 Jones fractures, all athletes were able to RTP, and the average time to RTP ranged from 6 weeks to 27 weeks. For complications, with operative treatment, the refracture rate ranged from 4 to 12%, and incomplete healing ranged from 7 to 50%. RTP was 15 weeks for refractures. There were no patient-reported outcomes. Conclusions: The vast majority of Zone 2/3 Jones fractures are treated with IM screw fixation with or without adjunctive orthobiologics, such as bone marrow aspirate concentrate, in NFL-caliber athletes. The six major series investigating outcomes after the operative treatment of Jones fractures in NFL players reveal very positive findings overall with regard to RTP, reoperation, and career continuation.
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Affiliation(s)
- Emily J. Luo
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Taylor Stauffer
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Caitlin Grant
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Christine J. Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Kevin A. Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
| | - Samantha Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (A.T.A.); (T.S.); (C.G.); (C.J.W.); (B.C.L.)
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Chopra A, Anastasio AT, Fletcher AN, Tabarestani TQ, Sharma A, Parekh SG. Short-Term Outcomes of Jones-Specific Implant Versus Intramedullary Screw and Plate Fixation for Proximal Fifth Metatarsal Fractures. J Foot Ankle Surg 2023; 62:862-867. [PMID: 37211269 DOI: 10.1053/j.jfas.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
Although intramedullary screw fixation is commonly performed for proximal fifth metatarsal fractures, high rates of nonunion, refracture, and hardware prominence have been reported. The Jones Specific Implant (JSI) is a novel surgical implant which contours to the native curvature of the fifth metatarsal allowing for a more anatomic fixation. The purpose of this study was to compare short-term complication rates and outcomes of patients treated with the JSI to other fixation types such as plates and intramedullary screws. Electronic records were queried for adult patients with proximal fifth metatarsal fractures who underwent primary fixation from 2010 to 2021. All patients were treated by a foot and ankle fellowship-trained surgeon with intramedullary screws, plates, or JSI (Arthrex Inc., Naples, FL). Visual analog scale (VAS) and the American Orthopedic Foot and Ankle Score (AOFAS) were recorded and compared using univariate statistics. Eighty-five patients underwent fixation using intramedullary screw (n = 51, 60%), plate (n = 22, 25.9%), or JSI (n = 12, 14.1%) with a mean follow-up of 11.1 ± 14.6 months. The total cohort demonstrated a significant improvement in VAS pain (p < .0001) as well as AOFAS (p < .0001) scores. When comparing the cohort treated with JSI and the cohort treated with all other types of fixation, there were no significant differences in postoperative VAS or AOFAS scores. Only 3 complications, one with JSI (3.5%) required removal of the symptomatic hardware. The JSI is a novel treatment for proximal fifth metatarsal fractures, with similar early outcomes and complication rates when compared with intramedullary screw and plate fixation.
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Affiliation(s)
- Aman Chopra
- Georgetown University School of Medicine, Washington, DC.
| | | | | | | | - Akhil Sharma
- Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, PA
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Chu ECP, Yun SMH, Huang KHK. Fifth Distal Phalanx Avulsion Fracture in a High-Level Marathon Runner. Cureus 2023; 15:e37468. [PMID: 37056221 PMCID: PMC10091159 DOI: 10.7759/cureus.37468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Fifth metatarsal fractures are common foot injuries that involve the long bone on the outer side of the foot, and avulsion fractures involving the short bone and the fifth distal phalanx of the foot have never been reported. A 25-year-old female marathon runner sustained an avulsion fracture of the distal lateral phalanges of the fifth metatarsal. The patient's high functional demands necessitated a conservative approach to minimize complications and facilitate efficient fracture healing. The patient underwent a comprehensive chiropractic rehabilitation program that focused on progressive weight-bearing exercises, range-of-motion activities, strengthening exercises, instrument-assisted soft tissue mobilization (IASTM), therapeutic ultrasound, and laser therapy to stimulate the speed of healing. The patient's progression was closely monitored throughout the rehabilitation process. Because of the nonoperative management and chiropractic rehabilitation, the patient successfully returned to her running activities within a six-week duration. This case demonstrates the effectiveness of nonoperative management and chiropractic rehabilitation in promoting the healing of avulsion fractures of the fifth metatarsal in high-level athletes. This conservative approach can facilitate a safe and efficient return to running activities while minimizing complications and reinjury risks.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
| | - Steve Ming Hei Yun
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
| | - Kevin Hsu Kai Huang
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
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Choudhry H, Singleton A, Candella K, Stegelmann S, Falbo R, Carmody C, Levine J. Return to play and performance in the National Basketball Association after undergoing operative or nonoperative treatment for foot fracture. J Orthop 2022; 34:160-165. [PMID: 36090784 PMCID: PMC9450068 DOI: 10.1016/j.jor.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 01/10/2023] Open
Abstract
Background The incidence of distal lower extremity fractures in National Basketball Association (NBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after sustaining foot fractures in these athletes. The purpose of this study is to quantify RTP rates and performance in NBA players after sustaining a foot fracture. Methods Sixty-two NBA athletes suffered foot fractures between 2005 and 2021 according to publicly accessible online data. Each athlete was matched to a control player based on age at start of career, age at index injury year, body mass index (BMI), and position played. Performance statistics from 3 seasons prior and 3 seasons following the index injury season were recorded. Results We found that players who suffered foot fracture injuries are expected to make a full recovery and reach their previous level of performance within three years. 100% of players treated nonoperatively returned to play; meanwhile only 90% of players who were treated operatively returned to play. This difference is statistically significant. Conclusion NBA athletes have a high RTP rate after sustaining a foot fracture. Players may experience an initial decrease in playing time and performance when returning to play, however, these variables were found to return to baseline over time. After three seasons, player statistics returned to baseline in mostly every category, including player efficiency rating (PER). We found that players are expected to make a full recovery and return to their previous level of performance, regardless of whether they were treated operatively or not. Players treated nonoperatively returned to play at a rate of 100% meanwhile those treated operatively returned at a rate of 90%. Therefore, it is our recommendation that players opt for nonoperative treatment when possible.
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Affiliation(s)
- Hassan Choudhry
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Amy Singleton
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Kristofer Candella
- Touro College of Osteopathic Medicine, 230 W 125 St 3rd Floor, New York, NY, 10027, USA
| | - Samuel Stegelmann
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Ryan Falbo
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Clayton Carmody
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Jason Levine
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
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Anastasio AT, Parekh SG. Existing fixation modalities for Jones type fifth metatarsal fracture fixation pose high rates of complications and nonunion. World J Orthop 2022; 13:408-410. [PMID: 35582152 PMCID: PMC9048496 DOI: 10.5312/wjo.v13.i4.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/12/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon, given documented high nonunion rates as well as high complication rates including hardware prominence, nerve injury, and screw breakage for existing treatment modalities including screw and plantar plate fixation. We call for the design of innovative Jones-fracture specific implants which contour to the natural curve of the fifth metatarsal. Future research should aim to expand upon existing literature for Jones fracture fixation and evaluate efficacy of novel implants which are designed to address unacceptably high complication rates for existing treatment modalities.
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Affiliation(s)
- Albert Thomas Anastasio
- Department of Orthopedic Surgery, Duke University Health System, Durham, NC 27710, United States
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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