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Lecture 16 parekh jones
This document discusses Jones fractures, which are fractures of the metaphyseal-diaphyseal junction of the fifth metatarsal bone. It describes the anatomy and vascular supply of the region. Treatment options include non-operative management with casting for non-athletic patients or operative fixation with screws for athletes or active patients to expedite healing. The technique of percutaneous screw fixation is discussed, emphasizing the importance of starting the guidewire "high and inside" the bone. Postoperative management and potential complications are also reviewed.
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Lecture 16 parekh jones
- 1. Jones Fractures Selene G.Parekh, MD, MBA Associate Professor North Carolina Orthopaedic Clinic Department of Orthopaedic Surgery Adjunct Faculty Fuqua Business School Duke University Durham, NC 919.471.9622 www.seleneparekhmd.com @seleneparekhmd
- 2. 5th Metatarsal Fractures •Consider in Zones Jones fx Diaphyseal fx
- 3. Jones Fracture • Fractureof the metaphyseal-diaphyseal junction • Must enter the 4/5 intermetatarsal articulation
- 4. Mechanism of Injury •Vertical and mediolateral forces concentrated over the 5th MT • Forced adduction • Can result in a fracture between shaft and immobile base • Greater propensity • Forefoot supination • Knee/ankle/hindfoot varus
- 5. Anatomy • Peroneus brevis •Peroneus tertius • Abductor digiti minimi • Lateral band of plantar fascia • Plantar and dorsal interosseous • Flexor digiti minimi brevis
- 6. Vascular Water-Shed •Periosteal plexus •Nutrientartery •Enters medial aspect of 5th MT at junction of proximal and middle third of bone •Metaphyseal and diaphyseal vessels
- 7. Jones Fracture: Non-Op •Indications • Elderly • Non-athletic • Low-demand • Protocol • NWB cast 4-8 weeks • 100 Fractures of 5th MT: Naval base • 72% union (avg. time 21.2 wks)Clapper, ClinOrth 1995
- 8. Jones Fracture: Non-Op •Protocol • Orthotic • No data
- 9. Jones Fracture: Operative •Indications • Athlete • Acute/stress fx • Active adult • Nonunion • Refracture • Cavovarus = lateral overload
- 10. Jones Fracture: Operative •Operative goals • Expedite healing • Quicker recovery; easier rehab • Decrease nonunion rate • Decrease refracture risk
- 11. Jones Fracture: Operative •Operative options • K-wiring and cast • Tension band wiring • IM curettage and casting • Mini-fragment screws • Low profile plates • IM screw fixation • Open • Percutaneous
- 12. Jones Fracture: Operative •ScrewFixation • Screw choices • 4.5 mm malleolar (Synthes) • 5.0 mm cannulated (ACE/DePuy) • 6.5 mm short thread (Synthes)
- 13. Jones Fracture: Operative •Nonunionafter percutaneous screw fixation are all with Cannulated Screws or Small Screws
- 14. Jones Fracture: Operative •Percutaneous Screw Fixation • Solid screw • Large fragment screws • Dedicated system • Cannulated bone preparation • Solid screw fixation
- 15. Jones Fracture: Set-up •Supine • Ankle block • Mini C-arm • Flex knee and place foot on base
- 16. Jones Fracture: Approach •Incision through skin only • 1 fingerbreadth proximal to base of 5th MT • Parallel to peroneals • Mosquito through wound to base of 5th MT
- 17. Jones Fracture: Approach •Solid screw into a curved bone
- 18. Jones Fracture: Approach •Guide pin • Entry site extremely important • Start “high and inside” • Central in the canal on AP and lat views
- 19. Jones Fracture: Technique •Entry drill • Tap to the correct screw diameter • 4.5, 5.5, 6.5mm • Feel the 5th MT head torsional forces
- 20. Jones Fracture: Technique •Measure length • Remove pin and drill guide • Place solid screw • Chose the largest solid screw that comfortably” fits the canal • Do not attempt to place down the entire MT
- 21. Insert Screw “Highand Inside” HIGH & INSIDE
- 22. Jones Fracture: Technique •Failure to start “high and inside” • Prominent screw head • Perforation of medial cortexstress riser
- 23. Jones Fracture: Technique •Avoid the headless tapered screw • Difficult to remove • Avoid plate • Prominent • If removed refracture
- 24. Jones Fracture • Postopmanagement • NWB x 2 weeks • WBAT in boot x 4 weeks • Physical therapy
- 25. Jones Fracture • Beginrunning in modified shoewear at 6-8 weeks if clinically nontender
- 26. Jones Fracture • Followradiographs • Healing may not be evident for 12 weeks 12 wks p.o.
- 27. Jones Fracture • Leavescrew forever!
- 28. Pitfalls of IMScrew • Infection • Delayed wound healing • Distal perforation (stress riser) • Sural neuritis/neuroma • Peroneal tendinitis • Persistent nonunion
- 29. Jones Fracture Nonunion •Hardware fatigue a sign of trouble
- 30. Jones Fracture Nonunion •Cavovarus? • Adequate fixation?
- 31. Jones Fracture Nonunion •If uncertain obtain CT
- 32. Jones Fracture Nonunion •Open Surgical technique • Remove hardware • Open bone graft • Iliac crest vs. allograft vs. substitutes vs. BMP • Re-fixation with largest screw
- 33. Jones Fracture Nonunion •Dwyer for varus
- 34.