DefinePK

Research Objective

To determine the radiological and functional outcome of acute Jones fracture treated conservatively in an early weight-bearing cast.

Methodology

A cross-sectional study conducted in the Orthopaedic Division of Lady Reading Hospital Peshawar from August 25, 2018, to November 13, 2022. Patients aged 18 years and above with isolated, undisplaced or minimally displaced (<2mm) closed Jones fractures (Zone II) presenting within seven days were included. Patients with non-union, delayed union, surgically treated fractures, or polytrauma were excluded. Patients were treated with a below-knee plaster cast and instructed to start weight-bearing as tolerated. Radiological union was assessed by callus and fracture line obliteration, and functional outcome was determined using the American Orthopaedic Foot and Ankle Score (AOFAS) after cast removal. Data was analyzed using SPSS version 23.

Methodology Flowchart

                        graph TD
    A["Patient Enrollment >=18 yrs, acute Jones fracture"] --> B["Inclusion/Exclusion Criteria Check"];
    B -- Included --> C["Apply Below Knee Cast"];
    B -- Excluded --> D["Exclude Patient"];
    C --> E["Instruct Early Weight Bearing as Tolerated"];
    E --> F["Regular Follow-up Radiological & Clinical Assessment"];
    F --> G["Assess Radiological Union"];
    F --> H["Assess Functional Outcome"AOFAS Score""];
    G -- Union Achieved --> H;
    G -- Non-union --> I["Document Non-union"];
    H --> J["Data Analysis"];
    I --> J;
    J --> K["Conclusion"];                    

Discussion

The study suggests that early weight-bearing cast immobilization is an effective conservative treatment for acute Jones fractures, achieving high union rates and excellent functional outcomes. The findings are consistent with some previous studies, but this study had a larger sample size and exclusively focused on Zone II fractures. The authors note that while some studies suggest similar outcomes with non-weight-bearing casts or walking boots, their results support early weight-bearing for improved functional recovery.

Key Findings

A total of 319 patients were included in the final analysis. The mean age was 34.41±4.29 years, with 76.80% being female. The right foot was involved in 66.14% of cases. The average union time was 6.2±1.2 weeks, with 99.0% of patients achieving union. Non-union was reported in only 0.94% of patients. The mean AOFAS score was 99.1±1.1, indicating excellent functional outcome. No significant difference in AOFAS scores was found based on gender, side, or fracture type (p>0.05).

Conclusion

Early weight-bearing cast is an effective modality for conservatively treating acute Jones fractures, demonstrating a high union rate and excellent functional outcomes. This technique offers high patient satisfaction and compliance with minimal complications, making it a recommended treatment of choice for undisplaced or minimally displaced acute Jones fractures (Zone II).

Fact Check

* Union Rate: The study reported a union rate of 99.0% (316 out of 319 patients).
* Mean AOFAS Score: The mean American Orthopaedic Foot and Ankle Score (AOFAS) was 99.1±1.1.
* Study Duration: The study was conducted from August 25, 2018, to November 13, 2022.

Mind Map