Fifth Metatarsal Injuries in NCAA Division I Athletes: Management and Return to Play

Abstract

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Optimal management of metadiaphyseal fifth metatarsal fractures (Jones fractures) in athletes remains controversial. In high-level athletes, surgical treatment with intramedullary screw fixation is commonly recommended to minimize the risk of nonunion and to allow for faster return to sport. The purpose of this study was to report the rate and time to return to sport in collegiate athletes who sustained an isolated fracture to the fifth metatarsal bone. Methods: From 2003 to 2020, we retrospectively reviewed the clinical notes and imaging studies of all athletes participating in NCAA Division I sports at a single college and who sustained a fracture of the fifth metatarsal bone. Athletes with a diagnosis of 5th metatarsal bone fracture were included. Athletes were excluded if they had a fracture in any of the other metatarsal bones (1st-4th). Data collected were: demographic information (age, gender), type of sport, date of injury and/or surgery, diagnosis of Jones fracture, type of treatment received (operative with intramedullary screw fixation versus non operative with the application of boot or cast of the lower extremity and non- weightbearing activity), rate of return to sport, and time to return to sport. The rate and time to return to sport were reported as percentage and mean-standard deviation, respectively. The level of statistical significance was set at <0.05. Results: From 2003 to 2020, we retrospectively reviewed the clinical notes and imaging studies of all athletes participating in NCAA Division I sports at a single college and who sustained a fracture of the fifth metatarsal bone. Athletes with a diagnosis of 5th metatarsal bone fracture were included. Athletes were excluded if they had a fracture in any of the other metatarsal bones (1st-4th). Data collected were: demographic information (age, gender), type of sport, date of injury and/or surgery, diagnosis of Jones fracture, type of treatment received (operative with intramedullary screw fixation versus non operative with the application of boot or cast of the lower extremity and non- weightbearing activity), rate of return to sport, and time to return to sport. The rate and time to return to sport were reported as percentage and mean-standard deviation, respectively. The level of statistical significance was set at <0.05. Conclusion: Jones fractures of the 5th metatarsal bone are a relatively rare injury in collegiate athletes at our institution occurring mostly in male football and basketball players at a rate of about one fracture per year for 21 intercollegiate teams. These fractures are treated with a high level of success with intramedullary screw fixation. Given that postoperative recovery may last for approximately 3 months, return to play following surgical fixation of a Jones fracture is highly dependent on the timing of injury; an athlete who sustains the injury in-season is unlikely to return to play that same season.