ABSTRACT
OBJECTIVE: To present a case of a high school football player with bilateral Jones fractures who was treated both conservatively and with acute intramedullary compression screw fixation. BACKGROUND: Jones fractures tend to heal slowly, have a propensity for reinjury, and a significant number progress to delayed union or nonunion. Because of the time constraints imposed by athletic seasons, there is a need to avoid lengthy periods of immobilization. DIFFERENTIAL DIAGNOSIS: Tuberosity fracture, metatarsal stress fracture. TREATMENT: Treatment options include either conservative care or acute intramedullary compression screw fixation. Jones fractures are difficult to treat and can cause prolonged disability. UNIQUENESS: The athlete was treated conservatively for a delayed union of an old stress fracture. X-rays revealed a sclerotic fracture line with partial union after 6 weeks. The athlete underwent open reduction and internal fixation using an intramedullary screw to obtain compression fixation and a graft to aid healing. Several months later, x-rays showed excellent resolution. One year later, he suffered a similar fracture of the other foot. Because of his history and his desire to return to play, he underwent open reduction and internal fixation using an intramedullary compression screw and was allowed to return to competition by the end of the sixth week postsurgery. CONCLUSIONS: Treatment of Jones fracture should be individualized, based on the athlete's needs, the history and clinical presentation, and the initial radiographic appearance of the injury. The literature indicates that a rapid return to activity can be realized using rigid internal fixation and may be the treatment of choice in athletes.
ABSTRACT
An intact segment of autologous fibula provides a strong, physiologic, anterior support in the surgical treatment of short segment kyphosis. In this series of 20 patients, only 3 had no signs of spinal cord injury. Correction averaged 20 degrees. At an average follow-up of 2.2 years, 9 degress of the previously obtained correction were maintained, including 3 patients with non-union and marked loss of correction. Twenty-four complications were noted in association with traction, surgery, and immobilization. The results suggest that attempts at correction should remain secondary to those of stabilization and relief or prevention of neurologic problems. Supplementary posterior spinal fusion is necessary to increase the strength of the stabilized segment as well as decrease the incidence of pseudoarthrosis and loss of correction.
