Early screw fixation versus casting in the treatment of acute Jones fracture

Purpose There is considerable variability in the literature in treatment of Jones fracture. The purpose of this study is to compare between the outcomes of cast immobilization and intramedullary screw fixation in treatment of acute Jones fracture type II and type III. Our results concluded that treatment of Jones fracture by early intramedullary screw fixation showed early union and return to previous activity in shorter time than the conservative treatment.Patients and methods In this prospective study, 40 patients were selected from Kasr El Ainy from October 2014 to May 2015. Radiographs were assessed for displacement. Dameron, Lawrence, and Quill classification was used to determine type of fracture. A total of 20 patients were treated conservatively by below-knee cast, and the average duration for cast application was 7 weeks. A total of 20 patients underwent operative management in the sort of percutaneous fixation by cannulated screw. We only used compression bandage after the operation; however, slab was used if there were any associated ipsilateral injuries. We followed up the patients with radiograph for union and by American Orthopedic Foot and Ankle Society Score to evaluate the function.Results All the surgical group patients achieved union, with an average clinical union of 7.5 weeks, and the cast group had an average union of 12.5 weeks, with highly significant difference (P<0.001). The complications in the cast group were more than the operative group. Conservative group showed nonunion in five patients, Sudeck's atrophy was seen in one patient, and one patient was complicated with superficial infection, which was treated by oral antibiotics.Conclusion Early screw fixation in the treatment of acute Jones fracture is preferable than conservative treatment in patients with high-demand physical activity who want to return early to their work, where we have to take in consideration the financial cost of the operation versus the cast application. So, tailoring of the management plan to the patient activity and financial capability is of utmost importance.