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Case Study: Failed Intramedullary Screw Fixation of a Proximal Metatarsal Fracture (Jones Fracture) in a Division 1 Athlete
Patient: A 21 year old, 6'9" male collegiate basketball player presents with right foot pain. The symptoms occurred after the athlete jumped and landed in an awkward position. He sustained a Jones fracture of the right foot nine months prior. The initial injury was treated surgically with an intramedullary screw fixation. The radiographs of the right foot revealed a nonunion of the proximal fifth metatarsal. The radiographs also showed bending forces within the screw. A CT scan exposed a 50% incomplete nonunion of the fifth metatarsal (14).
Intervention: The patient was scheduled for hardware removal, bone grafting, and screw exchange with a larger diameter intramedullary screw fixation. Compressive dressings were immediately applied post-surgery and transferred to a below-the-knee fiberglass cast five days postoperative (14).
Comparative: Surgical intervention is more favorable in competitive athletes when dealing with a Jones fracture. Early operative treatments with an acute Jones fracture will allow for a quicker timeline regarding bone union and return to play. Conservative treatment can be used for athletes where the time frame of return to activity isn't as crucial (14).
Outcome: The athlete had acquired bone union and was asymptomatic at six weeks post-surgical. At the three month follow-up complete consolidation was noted at the fracture site. The fracture was completely healed at five months and the patient was able to return to competition six months post-surgery (14).
Here's an example of the surgery that this athlete received. Disclaimer: this is not his actual surgery!
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