Jones Syndrome, Metatarsal Bone Fractures
Conditions
Keywords
Jones Fracture, Non-Surgical Management, Conservative Treatment, Walking Cast, Plaster Cast Treatment
Brief summary
This study is an open-label, randomized controlled trial comparing the effectiveness of two plaster cast methods-Short Leg Walking Plaster Cast and Walking Foot Plaster Cast-for treating Jones fractures, a common fracture at the base of the fifth metatarsal in the foot. This trial will be conducted at Lady Reading Hospital Peshawar. The study will evaluate differences in fracture healing and functional outcomes between these two treatment approaches. Findings from this trial may guide more evidence-based treatment protocols for Jones fractures, potentially improving patient mobility and recovery without requiring surgical intervention.
Detailed description
Jones fractures represent 26.3% of fractures at the base of the fifth metatarsal and are commonly treated conservatively through various weight-bearing casts. The lack of consensus on the optimal casting method for Jones fractures necessitates further study, particularly given the absence of published guidelines. This trial, unique in its randomized and prospective approach within Pakistan, aims to compare Short Leg Walking Plaster Casts and Walking Foot Plaster Casts specifically for Jones fractures. Patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups, with the primary endpoints being fracture healing (union) and functional outcomes at six weeks, assessed via radiographs and the American Orthopaedic Foot and Ankle Score (AOFAS). This study seeks to produce robust evidence to inform treatment guidelines, allowing patients, especially in low- and middle-income settings, to continue daily activities with minimal disruption during recovery.
Interventions
OTHERShort Leg Walking Plaster Cast
A short leg walking plaster cast that extends from the head of the metatarsal to the mid-calf. This cast provides stability to the fracture site while allowing limited weight-bearing, and is designed to restrict inversion and eversion movements, thereby reducing the risk of fracture displacement. Applied for six weeks.
OTHERWalking Foot Plaster Cast
A walking foot plaster cast that covers the foot from the metatarsal heads but leaves the toes exposed. This cast allows weight-bearing while restricting side-to-side movement, providing support to the fracture area without immobilizing the ankle. It will be used for six weeks.
Sponsors
Khyber Medical University Peshawar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
No masking due to the visible nature of the interventions (type of plaster cast), but the outcomes assessor is blinded to treatment assignment when evaluating follow-up outcomes.
Intervention model description
Two arms in parallel: One group receives the Short Leg Walking Plaster Cast, and the other receives the Walking Foot Plaster Cast.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Both genders * 18 years and above * Jones fractures that are un-displaced or minimally displaced (less than 2 mm) * Fractures presented within 7 days of injury
Exclusion criteria
* Significant foot swelling * Open fractures * Ipsilateral foot, ankle, or lower limb soft tissue pathology or fractures * Pathological fractures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fracture Union Rate | 6 weeks after cast application. | Measurement of fracture healing defined by callus formation and obliteration of the fracture line in 2 out of 3 cortices (lateral, medial, plantar) on X-ray, and absence of pain and tenderness at the fracture site, assessed by a senior orthopedic consultant. |
| Delayed Union Rate | 6 weeks, with further assessment at 8 weeks if needed. | Defined by insufficient callus in fewer than 2 cortices and persistent pain and tenderness at the fracture site. This assessment determines cases where additional casting or intervention may be necessary. |
| Nonunion Rate | 8 weeks post-cast application. | Nonunion is confirmed if there is insufficient callus formation in fewer than 2 cortices, with persistent pain and tenderness at the fracture site. |
| Functional Outcome (American Orthopaedic Foot and Ankle Score - AOFAS) | 6 weeks after cast removal. | Functional outcome assessed via the AOFAS scoring system, which includes pain (40 points), function (50 points), and alignment (10 points), with higher scores indicating better function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complication | Throughout the study duration up to 8 weeks. | Incidence of any complications, such as cast-related issues, skin irritation, or infection, during and after cast application. |
Countries
Pakistan
Outcome results
None listed