Focused extracorporeal shock wave therapy following intramedullary screw fixation for Jones fractures in high-level athletes may be associated with earlier bone union and return to sport

Background Focused extracorporeal shock wave therapy (F-ESWT) is widely used as a bone growth stimulator in the treatment of various bony injuries; however, no previous studies have specifically investigated the efficacy of F-ESWT following intramedullary screw fixation for Jones fractures in athletes. Objective To evaluate the efficacy of F-ESWT in promoting bone healing following intramedullary screw fixation for Jones fractures in high-level athletes. Methods This study retrospectively analyzed the treatment outcomes of intramedullary screw fixation using cannulated Herbert-type screws for Jones fractures between April 2017 and April 2023. All the study subjects participated in high-level sports activities (Tegner activity score ≥ 8) prior to injury. A total of 34 patients who met the inclusion/exclusion criteria were enrolled in the study. Among these subjects, 13 patients underwent F-ESWT as postoperative adjunctive therapy (ESWT group), while the remaining 21 patients underwent fracture fixation therapy without F-ESWT augmentation (Non-ESWT group). Application of F-ESWT to the fracture site was initiated at 2 weeks postoperatively and was repeatedly performed once a week for 3 to 4 sessions (administration of 2500 impulses; energy flux density of .20 to .25 mJ/mm 2 ; frequency of 4 Hz). Based on clinical records, outcomes including the time to achieve bone union, the time to return to the original sport at the pre-injury level, and the presence of any treatment failures or complications were evaluated and statistically compared between the groups. Results All patients in both groups achieved bone union and returned to their original sports activities at their pre-injury level. The median time to obtain bone union was 8 [interquartile range (IQR), 6-8] weeks in the ESWT group and 10 [IQR, 8-10] weeks in the Non-ESWT group ( P < .001). The median time to return to the participant's original sport was 9 [IQR, 8-10] weeks in the ESWT group and 12 [IQR, 10-12] weeks in the Non-ESWT group ( P < .001). Only one case of refracture occurred in the Non-ESWT group; however, statistical analysis of treatment failures and complications revealed no significant difference between the two groups ( P = 1.000). Conclusion The application of F-ESWT after intramedullary screw fixation for Jones fractures may be associated with earlier bone union and return to the original sport in high-level athletes. Further prospective studies with larger sample sizes, particularly randomized controlled trials, are needed to validate these preliminary findings.