Compression screw internal fixation versus non-weight-bearing cast immobilization for Jones fractures in children

Background: Several methods have been used to treat pediatric Jones fractures, but there has been no consensus about the optimum method. The purposes of this study were to compare the clinical outcomes between compression screw and non-weight-bearing techniques used in pediatric Jones fractures and clarify the most suitable treatment option for this population. Methods: Twenty-one patients who presented with Jones fractures between January 2015 and June 2021 were analyzed retrospectively. They were divided into the compression screw group (n=10) and cast immobilization (n=11) group. The following parameters were compared between them: demographic data; times to radiographic union, full weight bearing, and return to daily life; and the American Orthopaedic Foot and Ankle Society (AOFAS) foot scores at 3 months postoperatively and the final follow-up. Results: The two groups did not differ significantly with respect to age, sex, laterality, and preoperative displacement. The mean immobilization time and times to radiographic union, full weight bearing, and return to daily life were significantly shorter in the compression screw group than in the cast immobilization group. The AOFAS scores at the final follow-up did not differ significantly between the two groups. One case of refracture and delayed union each were observed in the non-weight-bearing cast group. However, no patients experienced nonunion. Conclusions: Compression screw and non-weight-bearing cast techniques are effective methods for treating pediatric Jones fractures. The complication rate was lower in pediatrics than in adults. However, compared with the non-weight-bearing cast technique, the compression screw technique has the advantages of a shorter radiographic union time, shorter immobilization times, and earlier return to full weight bearing and daily life. We recommend compression screw fixation for widely displaced fractures and school-age and active adolescents to avoid delays in healing, nonunion, disruption to daily living, and time off school. Level of evidence: Level III

Automated summary

This study compared the clinical outcomes of compression screw and non-weight-bearing techniques in treating pediatric Jones fractures. The results showed that compared to non-weight-bearing techniques, compression screw fixation can shorten the radiographic union time, immobilization time, and facilitate earlier return to full weight bearing and daily life. We recommend the use of compression screw fixation for widely displaced fractures and school-age active adolescents.