To Be(Ar) Or Not to Be(Ar) – Jones Dilemma?

Abstract

Category:Midfoot/ForefootIntroduction/Purpose:Jones fracture is the fracture of the base of 5th metatarsal and is a commonly encountered in the clinical setting. Its management has always been a subject of great debate with paucity of consensus on post- operative weight bearing protocols. We aim to evaluate the efficacy of early weight bearing in the post-operative management of Jones fracture and assess its association with radiological union and patient reported outcomes.Methods:Retrospectively, patients undergoing fixation of Jones fracture from January 2011 to December 2020 were identified. Radiographic follow-up of at least 8 weeks was required for inclusion yielding 40 patients. Patients were grouped by early weight bearing (EWB) as tolerated (26 patients) and non-weight bearing (NWB) for 2 weeks followed by partial weight bearing (14 patients). Medical records were reviewed for demographic variables, associated comorbidities, type of surgical construct used, fracture type, mode of injury and union. Delayed union was defined as patients without radiographic evidence of union at 12.5 weeks. Patients completed PROMIS physical function, PROMIS pain interference, and FFI scoring postoperatively.Results:The mean age was 42.83+- 17.03 years with a female gender predominance (n=23; 57.5%) and an average BMI of 32.2 +- 8.7. Thirteen (50%) in the EWB and 5 (43%) in NWB groups experienced delayed radiological union (>12 weeks) and this did not differ by group. There was one nonunion in the NWB group and none in the EWB group. The number of wound complications did not vary by group. Seventeen patients completed postoperative FFI and PROMIS scores at a median of 40 months (41.5 IQR). The FFI and PROMIS scores did not differ by group. In the EWB group, the median PROMIS scores were physical function 43.7 (6.7 (IQR)) and pain interference 52.8 (10.1) compared to physical function 44.0 (11.6) and pain interference 55.2 (11.8) in the NWB group. The median total FFI score in the EWB group was 20.0 (27) compared to 32 (32) in the NWB group.Conclusion:The EWB group exhibited comparable results to the NWB group after surgical fixation of Jones fracture. Importantly, PROMIS scores indicate both groups had comparable functional outcomes at long term follow up and were within a standard deviation of the general population of the United States (Score of 50 with SD of 10) for both pain and function. While further investigation is required, EWB may have equivocal results in terms of union, wound complications, and functional outcomes while allowing for early mobilization after Jones fracture fixation.