Jones fractures in the elite football player

The Jones fracture, defined as a proximal junctional metaphyseal/diaphyseal fracture of the fifth metatarsal, presents a challenge to the orthopaedic surgeon, especially in the competitive athlete. The purpose of this study is to characterize the Jones fracture in the elite athletic community and review the variety of treatments for these fractures in the National Football League (NFL). Between 1988 and 2002, 4758 elite collegiate football players participated in the NFL Combine. All athletes were evaluated clinically and radiographically. There were 86 Jones fractures identified in 83 athletes (incidence of 1.8%). Fifty-three percent (46 of 86) of the fractures were treated surgically. Eighty-nine percent (41 of 46) healed without complications and 7% (3 of 46) developed a nonunion. Twenty percent (8 of 40) of the fractures treated nonoperatively developed a nonunion while 80% (32 of 40) healed. The NFL injury surveillance system was also studied and revealed 17 Jones fractures occurred during the seasons 1996--2001. All of these fractures were treated with intramedullary screw fixation. The union rate was 94% (16 of 17 fractures). A questionnaire was also sent to all NFL team physicians regarding their experience with these fractures. The concensus was that this is not a common injury, but when it occurs, surgical treatment is recommended (77%) over nonsurgical treatment (23%). After reviewing the data, it was found that intramedullary screw fixation of Jones fractures is the treatment of choice for most physicians who treat elite collegiate and professional football athletes.