Heading into the weekend of October 1st, the Philadelphia Eagles were on a “bye,” which meant there wouldn’t be a big game for fans to watch on Sunday. Philly sports fans were left wondering, “what will we talk about over the weekend or over coffee on Monday morning?” But before anyone could even pose the question aloud, SportsCenter – via twitter – dropped a bomb on Philly sports fans: “BREAKING: No. 1 overall pick Ben Simmons [of the 76ers] fractures bone in right foot. Further medical evaluation & treatment options are being considered.”
While not the best news, it certainly had everyone talking. It was later confirmed that Simmons suffered what’s called an acute “Jones Fracture” in his foot – a fracture which involves a break in the fifth metatarsal. Daniel Farber, MD, an assistant professor of Orthopaedic Surgery, discussed the implications of the Jones fracture in aPhiladelphia Inquirer article shortly after the news broke, but to take a more in-depth look, we turned, again to Dr. Farber and to Samir Mehta, MD, chief of Orthopaedic Trauma, to find out how this type of injury could affect the average adult, and what the treatment may entail.
What is a Jones Fracture?
“A Jones Fracture is a fracture of the fifth metatarsal – the little toe – up by the middle of the foot,” Mehta said. “This is a concerning fracture because it is in a ’watershed’ area, meaning when there is a fracture, the blood flow is compromised so there is risk for the fracture not to heal.”
Farber added, “This fracture usually occurs in a similar manner as an ankle sprain. As the foot rolls inward and body weight leans over, the fourth metatarsal serves as a breaking point for the fifth metatarsal. When this happens the muscles pull to try and straighten the ankle, which can cause the bone to break due to the forces pulling on one side and the ground pushing on the other.”
Professional athletes’ aside, how common is this injury?
“The injury is not common, per se, but when it happens to an athlete, it comes to the forefront,” Mehta said. “More common is a pseudo-Jones fracture or avulsion fracture, which occurs near the same area of the fifth metatarsal, but does not carry the same risk for profile. There is also the stress fracture – another somewhat common injury – which occurs a little farther down the bone and is usually preceded by achy pain before the actual fracture happens. These stress fractures often can be problematic to heal for the same reasons as the true Jones fracture – the disruption of blood flow to the afflicted area.”
What does a typical treatment look like for this kind of fracture?
Farber, who specializes in foot and ankle surgery, said, “for a true Jones fracture, it is recommended that patients be placed in a short leg cast or controlled ankle motion (CAM) boot, and remain non-weight bearing for approximately six weeks. Patients then progress to full weight bearing activities as healing allows – of course, each patient is different. For more active patients, or patients that will have trouble with weight bearing restrictions, surgical treatment is often recommended. For a pseudo Jones fracture, the usual treatment is ’weight bearing activities as tolerated in a CAM boot’.”
What would the surgery for this injury entail?
“Surgery can be performed in a variety of ways including a single screw, small plate, or tension band wiring to stabilize the fracture,” said Mehta, who leads Penn’s Orthopaedic-trauma team. “The goal with surgery is to realign and compress the fracture to facilitate bone healing. The classic fixation uses a single screw inserted down the canal of the bone. For this method, the fragment of bone needs to be big enough and still be in one large piece – as opposed to broken into smaller fragments. If the bone is too small or is shattered into pieces, then an open procedure with a plate and screws or ’tension band’ construct would be recommended. In some complex cases, a bone graft – which involves taking healthy bone from one area and transplanting it to the fracture site to replace the damaged bone – can be performed to facilitate or accelerate healing.
How long is the recovery?
“In general, bone takes at least six weeks to heal to adequate strength, but healing is not complete at that point,” Farber cautions. “These kinds of fractures often take up to three months to fully heal. The wildcard, as Dr. Mehta mentioned, is the blood supply and making sure the healing bone is receiving enough blood flow. We also have to be aware of patient compliance, the rigidity of fixation – if surgery is done – and other factors such as whether the patient smokes, which can play a role in the healing time. X-rays and clinical exams are most commonly used to access healing, and for more complex cases, a computerized tomography (CT) scan can be helpful in monitoring the healing bone.”
Mehta elaborated, discussing the possibility of injuries that don’t heal. “For patients whose fractures don’t heal properly, who have a complication from surgery or if the surgery fails, recovery can be very long. The key to a good recovery lies in getting the bone to heal, and to do so properly, which can be a challenge. Surgery in and of itself does not guarantee healing.” Mehta explained what can happen when a bone does not heal or heals incorrectly in this post on nonunion and malunion fractures.
For an average adult, would there be any kind of extensive rehabilitation?
“Once the bone shows sufficient union, typically after a period of non-weight bearing and immobilization, a graduated weight bearing program can be started,” said Mehta. “Once the bone is almost completely healed, then a higher impact program can be started and patients can complete their full recovery. The programs are typically determined based on the patient’s lifestyle; what they are used to doing on a regular basis.”
Farber added, “the bone itself doesn’t need any rehabilitation, but rather rehab is more about regaining whatever strength is lost during the period of immobilization.”
And as the latest report from FOX Sports detailed, Simmons has undergone a successful surgery for his Jones fracture. Though we can’t say for sure how his injury will heal or when fans will see him back on the court, there could be a long road to recovery ahead.