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

OBJECTIVES: Jones fractures, which result in loss of playing time and subsequent dysfunction, remain a significant issue for elite contact athletes. The objectives of the present study are to (1) describe the epidemiology, surgical treatment, and impact on early National Football League (NFL) career of Jones fractures identified at the NFL Scouting Combine and (2) establish the value of computed tomography (CT) to determine healing following a Jones fracture in prospective NFL players. METHODS: All players who attended the NFL Scouting Combine (2009-2015) were retrospectively reviewed to identify those who previously sustained a Jones fracture with position of play, treatment method, and number of missed collegiate games recorded. Overall mean draft pick, number of games started and played, snap percentage, and position-specific performance scores (Fantasy Score) were compared between Jones fracture athletes and controls without any major injury prior to the NFL Combine and during first three years of NFL career. A classification system, based on the grading of four individual quadrants (plantar, dorsal, medial, lateral), was applied by three orthopaedic surgeons. RESULTS: Overall, the number of Jones fractures among athletes who attended the NFL Combine (2009-2015) was 72/2285 (3.2%) with all athletes treated via intramedullary (IM) screw fixation. 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 and defensive linemen. Subgroup CT scan analysis demonstrated a mean overall score of 2.5±1.3 with kappa values of 0.6 and 0.64 for inter- and intra-observer reliability, respectively. 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 least healing (56%), followed by the lateral cortex (46.9%). CONCLUSION: Although infrequent, Jones fractures are encountered at the NFL Combine with the highest prevalence at the tight end position and lowest at the running back position. Based on CT, 50% of all players with a previous Jones fracture demonstrate inhealing with least healing at the plantar and lateral cortices. Moreover, position-specific performance scores demonstrate worst performance at all positions for players with a previous Jones fracture versus controls.