Monday, April 25, 2011

Cannulated Screw Fixation of Jones Fifth Metatarsal Fractures: A Comparison of Titanium and Stainless Steel Screw Fixation

J. George DeVries, DPM, AACFAS 1, Daniel J. Cuttica, DO 2, Christopher F. Hyer, DPM, FACFAS 3

The classic Jones fracture involves the fifth metatarsal at the level of the proximal diaphyseal-metaphyseal junction. The mainstay of surgical treatment for the Jones fracture is intramedullary screw fixation. There is no consensus of the type or material of screw that should be used. The purpose of this retrospective cohort study was to test the hypothesis that there is no clinical difference in the incidence of healing, or complica- tions, when comparing stainless steel to titanium cannulated screws used in Jones fracture open-reduction internal fixation (ORIF). Data were collected on a total of 53 patients (fractures) that were fixed with either cannulated titanium screws (Ti group) or cannulated stainless steel screws (SS group). The postoperative protocol was standardized. The mean time to radiographic union was 11.7 ` 5.1 weeks in the Ti group and 13.4 ` 5.7 weeks in the SS group (P 1⁄4 .333). The overall union rate for the Ti group was 36/37 (97%) and 14/16 (88%) in the SS group (P 1⁄4 .213). Complications were rare in both groups, and the prevalence was not statistically significantly different (P > .05). There was 1 patient with an asymptomatic radiographic nonunion in the Ti group, and this patient elected not to undergo revision. There were 2 nonunions in the SS group. One was revised and went on to heal and the other is awaiting revision. Our study has demonstrated the decision to use stainless steel or titanium can be left to patient constraints, such as allergies, or physician preference without compromising the clinical result.

Level of Clinical Evidence:
Keywords: biomechanics injury ORIF nonunion surgery trauma

1 Staff Surgical Podiatrist, Ripon Medical Center, Ripon, WI 
2 Orthopaedic Surgeon, Center for Orthopaedic Surgery and Sports Medicine, Indianapolis, IN 
3 Fellowship Co-director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH

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