Headless compression screw fixation of Jones fractures: a clinical and radiographic comparison study

Abstract

Background: Promising results have been reported with indication-specific partially threaded screws and variable-pitched headless compression screws. Our objective was to compare clinical and radiographic results of Jones fractures treated with these two screw types. We also evaluated the association of patient and fracture characteristics with surgical failure. Methods: Retrospective review identified all Jones fractures treated with primary intramedullary screw fixation from 1995 through 2015. Chart review yielded patient and fracture characteristics, implants, postoperative course, and serial radiographs for fracture classification (Torg and anatomic zone) and radiographic union. The primary endpoint was surgical failure (delayed union, nonunion, or refracture). Secondary endpoints included time to radiographic union, weight bearing, and pain resolution. Results: Fifty-nine consecutive patients (47 with partially threaded screws and 12 with headless compression screws) with a mean age of 30 yr and follow-up of 9.6 mo were included. The group with partially threaded screws showed more failures (10/47, 21.3% vs. 1/12, 8.3%; P=0.31) and longer time to full weight bearing (4.2 vs. 3.3 wk, P=0.06), without differences in time to radiographic union or pain resolution. Pooled union rate was 96.6%. Conclusions: Factors significantly correlated with failure were age, diabetes, and body mass index, without significant correlation with tobacco or gender. No differences were found between zone II and III fractures. The two groups had similar clinical and radiographic results, both with high union rates. The 21% failure rate with partially threaded screws is concerning and may warrant further investigation. This supports the headless compression screw as a viable Jones fracture treatment. Level of Clinical Evidence: Level III.