Jones fracture screw vs cast

Early screw fixation versus casting in the treatment of acute Jones fractures.

Mologne TS, Lundeen JM, Clapper MF, et al. The American journal of sports medicine 2005 · PMID 15888715 · doi:10.1177/0363546504272262

Question

For acute Jones fractures of the fifth metatarsal, does early intramedullary screw fixation outperform non-weight-bearing casting?

Design

Randomised controlled trial (level I) of operative versus cast treatment.

Patients

Athletic patients with acute Jones fractures at the fifth metatarsal metaphyseal-diaphyseal junction.

Intervention

Early intramedullary screw fixation

Comparison

Non-weight-bearing cast immobilisation

Primary outcome

Time to union and return to activity; treatment failure

Key result

Screw fixation gave substantially shorter times to union and return to sport, while casting had a high failure rate from non-union, delayed union and refracture.

Limitations

Small sample of athletic patients; findings may not apply to less active or older populations.

Impact on practice

Distinguishes true Jones fractures (zone 2) from avulsion fractures; supports discussing early fixation for athletes and active patients, while most base-of-fifth avulsions are managed symptomatically.