Zogby R G, Baker B E
Department of Orthopaedic Surgery, SUNY Health Science Center at Syracuse 13202.
Am J Sports Med. 1987 Jul-Aug;15(4):304-7. doi: 10.1177/036354658701500402.
Sir Robert Jones, in 1902, described a transverse fracture of the proximal diaphysis of the fifth metatarsal, which he treated conservatively with good results. Since that time, classification into acute and chronic categories by several authors has been proposed and most agree with the relatively high incidence of non-union. Controversy exists concerning operative versus nonoperative primary treatment especially in athletes. The purpose of this study was to determine if nonoperative treatment could be used effectively in treating these fractures. A retrospective study of nine patients with 10 Jones' fractures was completed. The cases were categorized as acute or chronic by clinical history and radiographic appearance. The average age was 23.6 years. There were eight males and one female. In this group, competitive athletes sustained chronic fractures, while acute fractures occurred in nonathletes. Treatment consisted of a short leg nonweightbearing cast until radiographic and clinical healing occurred, followed by 6 weeks of limited activity. Mean clinical and radiographic union of chronic fractures was 9.4 weeks; acute fractures, 22 weeks. All competitive athletes returned to their preinjury level of competition at an average of 12 weeks following initiation of treatment. There was one refracture. Our data indicate that nonoperative treatment of early chronic or subacute fractures without intramedullary sclerosis can compare favorably with surgical treatment procedures reported in other studies in returning athletes to play postinjury. We suggest serious consideration be given to the method herein as a form of primary treatment of the early chronic Jones' fracture without intramedullary sclerosis.
1902年，罗伯特·琼斯爵士描述了第五跖骨近端骨干的横行骨折，他采用保守治疗，效果良好。从那时起，多位作者提出将其分为急性和慢性两类，大多数人都认同其不愈合发生率相对较高。关于手术与非手术的初始治疗，尤其是在运动员中，存在争议。本研究的目的是确定非手术治疗能否有效地治疗这些骨折。对9例患者的10处琼斯骨折进行了回顾性研究。根据临床病史和影像学表现将病例分为急性或慢性。平均年龄为23.6岁。有8名男性和1名女性。在该组中，竞技运动员发生慢性骨折，而非运动员发生急性骨折。治疗方法为短腿非负重石膏固定，直至影像学和临床愈合，随后进行6周的有限活动。慢性骨折的平均临床和影像学愈合时间为9.4周；急性骨折为22周。所有竞技运动员在开始治疗后平均12周恢复到受伤前的比赛水平。有1例再骨折。我们的数据表明，对于早期无髓内硬化的慢性或亚急性骨折，非手术治疗在使运动员伤后重返赛场方面，与其他研究报道的手术治疗方法相比具有优势。我们建议认真考虑本文所述方法，作为早期无髓内硬化的慢性琼斯骨折的一种初始治疗方式。
