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Use of a partially threaded screw
3%
96/3384
Use of cannulated screw
7%
234/3384
Absence of adjunctive ultrasound stimulator use
1%
38/3384
Return to play prior to radiographic union
84%
2846/3384
Use of a 5.0mm diameter screw
5%
154/3384
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Radiographic views demonstrate a bent 5.0 mm cannulated intramedullary screw along with incomplete healing of the left proximal 5th metatarsal fracture. It is important to note that return to full activity prior to radiographic union is directly related to the risk of potential treatment failure. The study by Larson et al examined 15 patients (mean age 21.7 years) who underwent cannulated screw fixation of a Jones fracture between 1993 and 1999. There were 6 failures: four refractures and two symptomatic nonunions. The mean time to full activity was 6.8 weeks for the patients with failure, compared with 9 weeks for patients who did not have complications. Although all patients were asymptomatic and radiographically progressing to union before return to full activity, only one of 6 patients with failures had complete radiographic union, compared with 6 of 7 patients with no complications. There was a higher proportion of elite athletes among the failure group (83%) compared with those without complications (11%). This study showed no significant differences in age, sex, screw diameter, use of bone graft, or age of fracture between patients with failures and those without complications. However, it should be noted that other studies have reported that smaller sized and cannulated screws may be risk factors for treatment failure. An appropriate treatment for the bent, failed hardware is removal of the hardware and placement of a larger intramedullary screw (Illustrations A and B).
2.8
(36)
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