This retrospective case series evaluates revision surgery for Jones fracture nonunions and refractures in elite athletes. It asks whether intramedullary screw fixation combined with bone grafting can reliably achieve union and restore athletes to competition.
Jones fractures in elite athletes have an unacceptably high nonunion and refracture rate with nonoperative care, making primary screw fixation standard. But even after operative fixation, hardware failure, aggressive rehab, and poor local biology can lead to nonunion or refracture — and there was little published guidance on what to do next.
When you encounter a Jones fracture nonunion or refracture in a competitive athlete, this paper supports revision with open debridement, a solid partially-threaded screw (5.5 mm or larger), and autologous bone grafting. Upsize the screw from the index fixation whenever the canal allows.
For graft choice: iliac crest cancellous autograft remains the reference standard, but BMA combined with DBM is a reasonable alternative with equivalent outcomes and potentially less donor-site morbidity. The 4-cortex healing criterion on plain radiograph is the practical threshold for clearing an athlete to run. CT adds value only when return-to-sport timing is critical (in-season athletes).
This retrospective case series evaluates revision surgery for Jones fracture nonunions and refractures in elite athletes. It asks whether intramedullary screw fixation combined with bone grafting can reliably achieve union and restore athletes to competition.
Jones fractures in elite athletes have an unacceptably high nonunion and refracture rate with nonoperative care, making primary screw fixation standard. But even after operative fixation, hardware failure, aggressive rehab, and poor local biology can lead to nonunion or refracture — and there was little published guidance on what to do next.
When you encounter a Jones fracture nonunion or refracture in a competitive athlete, this paper supports revision with open debridement, a solid partially-threaded screw (5.5 mm or larger), and autologous bone grafting. Upsize the screw from the index fixation whenever the canal allows.
For graft choice: iliac crest cancellous autograft remains the reference standard, but BMA combined with DBM is a reasonable alternative with equivalent outcomes and potentially less donor-site morbidity. The 4-cortex healing criterion on plain radiograph is the practical threshold for clearing an athlete to run. CT adds value only when return-to-sport timing is critical (in-season athletes).