5<sup>th</sup> Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?

PURPOSE OF THE STUDY
\nFifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general pop ulation and athletes. Although discussions about whether the surgical or conservative solution should be preferred are
\nongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis
\nusing the Herbert screw with the conservative solution in patients from our department.
\nMATERIAL AND METHODS
\nPatients 18–50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria
\nwere offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping
\nthe coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient
\nand AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was
\nbelow 80 after six weeks were offered surgery again.
\nRESULTS
\nOf 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six
\nweeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this
\nscore exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing
\nafter six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the
\nconservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six
\nweeks opted for surgery at that time and all improved significantly by the twelfth week.
\nDISCUSSION
\nAlthough studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an un common method of surgical treatment of this injury – the use of the Herbert screw. The results of this method are excellent
\nand even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover,
\nthe surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. 
\nCONCLUSIONS 
\nOsteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment.