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Review Question - QID 341

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QID 341 (Type "341" in App Search)
a 19-year old collegiate football lineman sustains a twisting injury to his right foot 1 week ago and radiographs are shown in Figure A. He was initially treated with a short leg splint, non-weight bearing and elevation. What treatment offers the fastest time to bony union and return to sport?
  • A

short leg cast and non weight bearing

1%

26/1737

long leg cast and non weight bearing

1%

11/1737

intramedullary screw fixation

89%

1544/1737

k-wire fixation

2%

41/1737

plate and screw fixation

6%

100/1737

  • A

Select Answer to see Preferred Response

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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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