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PROXIMAL FIFTH METATARSAL STRESS FRACTURES; SCREENING AND TREATMENT FOR INCOMPLETE FRACTURES
  1. Hiroko Ueki1,
  2. Tomohiko Tateishi2,
  3. Saisei AN3,
  4. Daisuke Hatsushika3,
  5. Hideyuki Koga1,
  6. Takashi Ogiuchi3
  1. 1Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Bunkyo, Japan
  2. 2Doai Memorial Hospital, Sumida, Japan
  3. 3Kawaguchi Kogyo General Hospital, Kawaguchi, Japan

    Abstract

    Background Proximal fifth metatarsal stress fractures (so called Jones fractures) usually occur due to chronic repetitive forces. Soccer players on the status of incomplete fracture don't complain about pain while playing soccer; they can keep playing until progressing to the state of complete fractures. Jones fractures are known for prolonged healing time, high rate of non-union and re-injury. Therefore, it is critical to screen athletes with incomplete fracture.

    Objective To evaluate the effectiveness of "Jones fracture screening" on its prevention for progression from incomplete to complete fracture.

    Design Prospective cohort study.

    Setting Collegiate and high school soccer players.

    Patients Seventy-six players who agreed to participate in the primary screening test.

    Interventions Educational lectures regarding Jones fracture, questionnaires as well as medical checkup including physical examination and ultrasound were conducted in players' school gymnasium as a primary screening. Hump sign, defined as cortex bulging, and increased blood flow around the fracture area in the Doppler ultrasound were defined as positive. Secondary medical examination with X-rays was then conducted for those who were positive for the primary screening. Players with Jones fractures identified by X-rays were then treated conservatively and followed up until radiographic bone union was achieved.

    Main Outcome Measurements Radiographic bone union.

    Results Sixteen players were screened as positive in the primary screening. All positive players received secondary examination, and three players with Jones fracture were identified. Two players had an incomplete fracture and another had an old incomplete fracture. In all players bone union was achieved after conservative treatment without quitting playing soccer.

    Conclusions The use of ultrasonography would be effective to diagnose incomplete Jones fractures. Jones fracture screening can enlighten about the risk of Jones fractures and may prevent soccer players from progressing from incomplete to complete fracture without quitting playing soccer.

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