Biologic Augmented Fixation vs Fixation Alone: Differences?

Biologically augmented fixation of Jones fractures results in slightly higher fracture union rates than fixation alone. Rates of return to play and time to return to play were similar for either approach, according to a new meta-analysis and review of the literature.

“The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated,” the researchers wrote.

In their study, the research team quantified the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes. They reviewed several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library and Clinical Trials to identify relevant studies through March 2021.

The primary outcome data included the rate with which athletes returned to play and how much time it took to return to play. Secondary outcomes included time to union, union rate, and refractures.

Overall, in the biologically augmented fixation group, successful return to play was reported in 195 (98.98%) of 197 fractures (OR, 97.5%, 95% CI, 95.8%-100%, I² = 0), with a mean time to return to play of 10.3 weeks (95% CI, 9.5-11.1 weeks, I² = 99%).

In the fixation with augmentation group, successful return to play was reported in 516 of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I² = 0], with a mean time to return to play of 9.7 weeks (95% CI, 7.84-11.53 weeks; I² = 98.64%].

Fracture union was achieved in 194 of the 197 fractures in the biologically augmented fixation group (OR, 97.6%; 95% CI, 95.5%-99.7%; I² = 0). The mean time to fracture union was 9.28 weeks (95% CI, 7.23-11.34 weeks; I² = 98.18%). For the fixation alone group, fracture union was achieved in 407 of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I² = 0%). The mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I² = 98.81%).

“Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone, but similar rates of return to play and time to return to play. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high-quality comparative studies are required to establish the indication for orthobiologic augmentation,” the researchers wrote.

The study, “Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systemic Review and Meta-analysis of 718 Fractures” was published online on May 25,2022 in The American Journal of Sports Medicine. 

Study authors included Ahmed Khalil Attia, M.D., of Hershey Medical Center, Greg A.J. Robertson, MBChB, BMedSci (Hons), MSc, Ph.D., of Edinburgh Orthopaedic Trauma Unit, Edinburgh UK, John McKinley, MBChB, of Royal Infirmary of Edinburgh, Edinburgh UK, Pieter P. d’Hooghe, M.D., MSc, MBA, Ph.D., of Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar, and Nicola Maffulli, M.D., M.S., Ph.D., of the University of Salerno, Italy.