September 2016

Jones fracture outcomes in pros bode well for less-elite athletes

9FOOTnews-Metfracture-shutterstock_59667433Most return to preinjury skill level

By Chris Klingenberg

Studies reporting high return-to-play rates after Jones fracture in National Basketball Association (NBA) and National Football League (NFL) players suggest positive outcomes are also achievable for athletes who compete at less elite levels.

“I believe that the conclusions are applicable to the general athletic population as a whole,” said John Begly, MD, a resident in the Department of Orthopaedic Surgery at the New York University School of Medicine. “Foot fractures, and Jones fractures specifically, tend to carry an ominous connotation in the athletic population. When treated correctly, athletes with these injuries can predictably return to their preinjury level of performance.”

Begly and colleagues analyzed 26 NBA players who had sustained an acute Jones fracture (involving the metadiaphyseal junction of the fifth metatarsal) during competition in an NBA game between the 1994-1995 and 2012-2013 seasons. Twenty-four athletes (92%) were treated with operative fixation and three (12%) underwent secondary reoperation. The mean age at the time of injury was 24.8 years. The athletes’ mean body mass index (BMI) was 24.7 kg/m2, and the mean experience prior to injury was 4.1 NBA seasons.

“In NBA athletes, who by all accounts are among the largest, most explosive athletes in all of sports, the forces are even more pronounced [than in most athletes],” Begly said. “So I’d say a combination of the forces associated with explosive athletes, as well as the sport-specific motions of the game of basketball, is what causes Jones fracture injuries in NBA players.”

The pounding experienced by the feet of basketball and football players contributes to the risk of Jones fracture injury in both sports.

Four players (15%) did not return to play in a subsequent NBA game after the season in which a Jones fracture was sustained, and there were five cases of injury recurrence (19%).

Player efficiency rating (PER, a measure of a player’s statistical contributions) one and three years prior to injury and following injury were assessed for all injured players, and postinjury PER values for injured players were compared with those of uninjured control players who were matched for position and baseline performance. Average PER one year after injury was about one point lower than at one year preinjury, but that difference was not statistically significant, and the pre-to-post­injury change in PER for the injured players did not differ significantly from the control group at the same time point. PER three years after injury was about half a point lower than at three years preinjury, and again the pre-to-postinjury change in PER did not differ significantly from the control group.

The findings were published in the July issue of Sports Health.

In a separate study, researchers at the OrthoCarolina Foot & Ankle Institute in Charlotte, NC, conducted a study on NFL players who had surgery for a Jones fracture between 2004 and 2014.

The analysis included 25 NFL players who underwent screw fixation of an acute zone II or III proximal fifth metatarsal fracture by a single foot and ankle fellowship-trained orthopedic surgeon. The most common positions played at the time of injury were wide receiver (32%), linebacker (16%), and tight end (16%). The average BMI was 31 kg/m2.

As in the NBA study, the injured NFL players were young, with an average age of 24 years. Nineteen players (76%) underwent operative fixation during the time between the predraft NFL Scouting Combine and their third season in the league. Twelve players (48%) were diagnosed before or during their rookie season.

The average time between injury and surgery was 8.5 days. Of the 14 players for whom the surgery’s timing made return to play during the same season possible, the average time to return to play was 8.7 weeks (range 5.9-13.6 weeks).

All of the injured players returned to play, and 80% were still playing at the end of the 2014-2015 season. At the study’s completion, the average number of seasons played postinjury was 2.7. The findings were published in the January 2016 issue of Foot & Ankle International.

The skills required to excel in the NFL may differ from those needed in the NBA, but the pounding experienced by the feet in both sports contributes to the risk of Jones fracture injury, said first author Craig Lareau, MD, who is now a foot and ankle surgeon with New England Orthopedic Surgeons in Springfield, MA.

“Field athletes wearing tight-fitting cleats and court players withstand substantial repetitive loading at the fifth metatarsal base, both predisposing them to this injury initially and increasing the likelihood of recurrence,” Lareau said.

Chris Klingenberg is a freelance writer based in Massachusetts.

Sources:

Begly JP, Guss M, Ramme AJ, et al. Return to play and performance after Jones fracture in National Basketball Association athletes. Sports Health 2016;8(4):342-346.

Lareau CR, Hsu AR, Anderson RB. Return to play in National Football League players after operative Jones fracture treatment. Foot Ankle Int 2016;37(1):8-16.

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