SLR - March - Shawn Kashef, DPMTitle: Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures
Reference: Attia AK, Robertson GAJ, McKinley J, d’Hooghe PP, Maffulli N. Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures. The American Journal of Sports Medicine. 2022;0(0).
Level of Evidence: 4
Reviewed By: Shawn Kashef, DPM
Residency Program: Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Oakland, California.
Podiatric relevance: Fifth metatarsal Jones fractures are one of the most common fractures of the foot. In healthy young patients, concern for fracture healing is usually very minimal once adequate reduction has been achieved. Due to the location and anatomy of the Jones fracture however, there is higher concern for non-union. This article is a systematic review to determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes.
Methods: This review included studies with proximal fifth metatarsal (Jones) fractures with at least one of the following outcomes: RTP (return to play) rate, time to RTP, time to union, union rate, and re-fracture. This review excluded studies that did not reporting biologics used, reported exclusively on Zone 1 5th metatarsal fractures, or studied on non-athletic populations (Athletes defined as those participating in elite level ie. national-level athlete, Olympic level, and collegiate level)
Results: Of the 718 Jones fractures reviewed, 621 (72.56%) underwent fixation without augmentation, while 197 (27.44%) underwent biologically augmented fixation. The mean age of the population studied was 22.4 years. The authors noted a higher union rate (98.5%) when Jones fracture fixation is combined with orthobiologic augmentation in comparison with fixation alone (93.8%). The authors also found similar RTP rates between both groups (99% vs. 99%) and time to RTP of 10.3 weeks with biologics vs. 9.7 weeks without biologics.
Conclusion: The authors concluded that orthobiologic augmentation of jones fractures resulted in higher fracture union rates than fixation alone, but carries similar rates of RTP and time to RTP. Given the large sample size, a ~5% difference in union rates is significant, especially dealing with young and healthy athletes. Surgical union is never guaranteed with fracture reduction and fixation and Jones fractures are at a higher propensity of non-union given the vascular watershed. The use of orthobiologics such as bone graft, bone marrow aspirate, and demineralized bone matrix has been expanding with their potential to aid in fracture healing. There is little downside to using orthobiologics, so it is something that should be strongly considered when dealing with this type of fracture.