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short leg cast and non weight bearing
1%
26/1737
long leg cast and non weight bearing
11/1737
intramedullary screw fixation
89%
1544/1737
k-wire fixation
2%
41/1737
plate and screw fixation
6%
100/1737
Select Answer to see Preferred Response
Figure A shows a Zone 2 base of fifth metatarsal (Jones) fracture. Elite athletes have been shown to have faster time to union with open reduction internal fixation of these fractures, as compared to non-operative management. In the average patient with a Jones fracture, treatment is largely non-operative. These fractures are usually treated with casting and advised to be non-weightbearing for 6-8 weeks (union rates shown to be between 72% to 93%). In the athletic population, early intramedullary screw fixation has shown to improve postoperative outcomes by shortening the time to union as well as increasing the overall union rates. Porter et al. reported on a case series of 23 athletes, followed up 22 months with 98.9% healing on radiographs with return to sport in 7.5 weeks. There were no reports of re-fracture in this series. Kelly et al. created, in human cadavers, 23 pairs of fifth metatarsal fractures. The fractures were then fixed using either 5.0 mm or 6.5 mm screws. They found that larger diameter screws did not result in greater fracture stiffness but did result in significantly greater pull-out strengths. Figure A shows a minimally displaced Jones fracture. Incorrect Answers: Answer 1,2,4,5: Internal fixation will allow for a more rapid return to sport than nonoperative management. However, return to sport prior to radiographic union may lead to high rates of hardware failure and loss of fixation.
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