Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and

Initial Career Performance1Robert Spang, MD, 1Daniel B. Haber, MD, 2Brendin R Beaulieu-Jones, BA, 1Kristen Stupay, MD, 3George Sanchez, BS, 4Jim Whalen, ATC, 4Joe Van Allen, ATC, PT, 1,4Mark D. Price, MD,

PhD, 3,5Matthew T. Provencher, MD, CAPT, MC, USNR1Massachusetts General Hospital, Boston, MA, USA 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 3Steadman Philippon Research Institute, Vail, CO; 4New England Patriots,

Foxborough, MA, USA, 5The Steadman Clinic, Vail, CO, USA

Jones fractures, which result in loss of playing time and subsequent dysfunction, remain a significant issue for field sport athletes.

To (1) describe the epidemiology, surgical treatment, and impact of Jones fractures identified at the National Football League Combine on early NFL career and (2) establish the value of computed tomography (CT) to determine bony healing following a Jones fracture in prospective NFL players.

Hypothesis/Purpose

Background

Axial, sagittal, and coronal CT images of a representative non-fractured fifth metatarsal illustrating the percentage of completely healed cortices in each quadrant

Overall, the number of Jones fractures identified in athletes attending the NFL Combine between 2009-2015 was 72/2285 (3.2%) with all athletes treated via intramedullary (IM) screw fixation.

ResultsThe mean overall draft pick for Jones fracture players was 111.2 (SD 67.9), compared to a mean of 99 for controls (SD 65.9) (p=0.12). Position-specific performance scores for players with a previous Jones fracture were lower than controls across all positions with a significant difference in running backs (2.6 vs 4.0, p<0.001) and defensive linemen (1.4 vs 2.3, p=0.03). CT scan mean score was 2.5+/- 1.3. A total of 16 Jones fractures (50%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (17/32, 56%), followed by the lateral cortex (15/32, 46.9%). The group with mean grade of <1 was found to have fewer games started (2.7, SD 2.5) than players with 1,2, or 3 cortices healed (18.5 GS, SD 10.9) or players with all cortices healed (8.5 GS, SD 11.4).

Based on CT, 50% of all players with a previous Jones fracture demonstrate incomplete healing with least amount of healing demonstrated at the plantar and lateral cortices. Moreover, position-specific performance scores over first 2 years of NFL career demonstrate worse performance at all positions for players with a previous Jones fracture versus controls. CT scans with scores <1 (1/4 cortices healed) were found to start fewer games and were drafted later than controls. Jones fractures, especially those with minimal healing, may be a concern for future NFL play.

Conclusion

All players who attended the NFL Scouting Combine (2009-2015) were retrospectively reviewed to identify those who previously sustained a Jones fracture. Position of play, treatment method, and number of missed collegiate games were recorded. Overall mean draft pick, number of games started (GS) and played (GP), snap percentage (SNAP %), and position-specific performance scores (Fantasy Score) over the first two years in the NFL were compared between athletes with Jones fractures and controls. A computed tomography (CT) classification system, based on the grading of four fifth metatarsal quadrants (Plantar, dorsal, medial, lateral) score of “0” –not healed vs “1” – healed per quadrant, with a maximum healed score of “4”, was applied by three orthopaedic surgeons.

Methods

Score Frequency N (%)

Number of Missed Games

Jones Fx

Played 2yrs in

NFLOverall

pickGames played

Games started

0.0<1.0 4 (12.5) 0.25 (0.5) 3 (75.0) 153.3 (51.5)

20.0 (8.7) 2.7 (2.5)

1.0<3.0 12 (37.5) 0.08 (0.29) 7 (58.3) 110.8 (75.6) 25.6 (8.3) 17.4 (10.4)

3.0≤4.0 16 (50.0) 0.25 (1.0) 13 (81.3) 129.2 (80.7)

18.5 (9.7) 8.7 (11.2)

ANOVA --- 0.83 0.43 0.69 0.28 0.10

All cases 32 0.19 (0.74) 23 (71.9) 125.4 (74.6)

20.9 (9.4) 10.6 (11.1)

Controls 297 --- 264 (88.9)

99.0 (65.9) 25.3 (6.5) 13.4 (10.6)

T-test --- 0.31 0.003 0.03 0.002 0.11Cases (n=28) include all players with a confirmed fifth metatarsal base fracture who had undergone CT scan following prior intramedullary screw fixation; cases were stratified based upon cumulative quadrant score into three groups: 0.0<1.0, 1.0≤3.0, and 3.0≤4.0. An ANOVA was completed to assess differences among the three groups. Two-sample, two-tailed T-tests were completed to assess differences between cases and controls.