JONES FRACTURE: WHAT’S AILING KEVIN DURANT?

Kevin Durant has been dealing with right foot/ankle pain since suffering the initial injury a couple months prior to the 2014-2015 NBA season.  The initial surgery was performed in September 2014 to place a screw to adhere the 2 ends of the fracture together.  Kevin Durant returned in early December and played through the All-Star break only to have another procedure to replace the screw secondary to constant irritation.  Now he will have another procedure to remove the screw and have a bone graft over the fracture site.

So, this blog will discuss what is a Jones fracture, reasons for delayed healing, and anticipated outcomes following bone graft procedure.

WHAT IS A JONES FRACTURE?

                      

A Jones fracture is a fracture of the 5th metatarsal bone that leads to the pinky toe, between the diaphysis and metaphysis.  Diaphysis is the shaft of the 5th metatarsal and metaphysis is the base of the 5th metatarsal (seen above).  This type of fracture usually occurs when increased force is placed on the lateral aspect of the foot while in plantar flexion.  Jones fractures are usually seen in sports where cutting and pivoting are a prime component of the sport (basketball and soccer). It can also occur because of sudden deceleration with the foot in plantar flexion and inversion.  This type of fracture can be improperly diagnosed because many times any fracture of the 5th metatarsal, especially near the base, will be diagnosed as an avulsion fracture.  An avulsion fracture is where a portion of the bone tears away from the main bone mass and occurs where tendons attach to the ends of bones.

REASONS FOR DELAYED HEALING

As with any foot injury, healing times associated with foot/ankle injuries are usually extended secondary to the foot being the farthest from the heart.  Furthermore the location of the Jones fracture directly disrupts the blood supply to the lateral portion of the foot.  Another reason for delayed healing is returning to physical activity too soon.

BONE GRAFT SURGERY

For every Jones fracture, 5 to 8% require the use of a bone graft to completely repair the fracture.  Initial treatment is casting with non-weight bearing as long as the fracture is minimal.  If non-union continues, initial surgical intervention will consist of using a screw to approximate the ends of the bone and continued non-weight bearing.  For the 5 to 8% that require bone graft surgery, research shows time to union usually takes 21 weeks.  The greatest predictor for poor functional outcome is the amount of time spent in non-weight bearing.  Once weight bearing restrictions are lifted, weight bearing should be encouraged with gradual progression to more strenuous activities.

REFERENCES:

Benjamin John, Floyd Dean, Alpesh Kothari, Harpal Uppal, and Raghubir Kankate.  The Jones Fracture Classification, Management, Outcome, and Complications: A Systematic Review. Foot and Ankle Specialist,  August 2012; vol. 5, 4: pp. 256-259

Sueki, D., Brechter, J. (2010) Orthopedic Rehabilitation Clinical Advisor. Maryland Heights, Missouri: Mosby, INC.