Orthopaedic Associates of Michigan, Orthopaedics, 1111 Leffingwell Ave NE, Grand Rapids, MI 49525, USA.
Foot Ankle Int. 2011 Jun;32(6):603-8. doi: 10.3113/FAI.2011.0603.
Nonunion following a proximal fifth metatarsal metaphyseal-diaphyseal or Jones fracture can cause considerable pain with high morbidity and loss of work. Treatment should aim for early union, thus allowing early return to activity. The present study evaluated the outcomes and the time required for union following closed intramedullary screw fixation for this condition.
Between January 2005 to August 2009, 14 patients were diagnosed with nonunion following a Jones fracture. Mean age at surgery was 49 years. Mean duration from injury to surgery was 28 weeks. All nonunions were fixed with a single intramedullary screw inserted from the base of the fifth metatarsal without opening the nonunion site. Serial postoperative radiographs were evaluated to determine union. Time required for return to activity was determined. Outcome was assessed with help of pain scores. Mean followup was 27 months.
Union was achieved in all 14 patients with one delayed union. Mean time to union was 13.3 (range, 8 to 20) weeks. All patients were able to start unassisted full weightbearing without pain at mean 10.2 weeks. Overall pain score improved from a preoperative mean of 5.4 to postoperative mean of 1.0. Complications included one deep infection, one delayed wound healing and one sural neuroma.
Closed intramedullary screw fixation achieved an excellent union rate when used in the treatment of nonunion of a Jones fractures.
第五跖骨近段干骺端-骨干或 Jones 骨折后不愈合可导致严重疼痛，发病率高，丧失工作能力。治疗应旨在早期愈合，从而允许早期恢复活动。本研究评估了闭合髓内钉固定治疗这种情况的愈合情况和所需时间。
2005 年 1 月至 2009 年 8 月，诊断为 Jones 骨折后不愈合的 14 例患者。手术时的平均年龄为 49 岁。从受伤到手术的平均时间为 28 周。所有不愈合均采用单个髓内钉从第五跖骨底部插入固定，不打开不愈合部位。定期进行术后 X 线检查以确定愈合情况。确定恢复活动所需的时间。借助疼痛评分评估结果。平均随访时间为 27 个月。
14 例患者均愈合，其中 1 例延迟愈合。平均愈合时间为 13.3 周（范围为 8 至 20 周）。所有患者在平均 10.2 周时均能无痛地开始不受限制的完全负重。总体疼痛评分从术前的 5.4 分改善到术后的 1.0 分。并发症包括 1 例深部感染、1 例伤口愈合延迟和 1 例腓肠神经瘤。
闭合髓内钉固定治疗 Jones 骨折不愈合的愈合率很高。
