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Range limitation in hip internal rotation and fifth metatarsal stress fractures (Jones fracture) in professional football players

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify unknown risk factors associated with fifth metatarsal stress fracture (Jones fracture).

Methods

A case–controlled study was conducted among male Japanese professional football (soccer) players with (N = 20) and without (N = 40) a history of Jones fracture. Injury history and physical examination data were reviewed, and the two groups were compared. Univariate and multivariate logistic regression controlling for age, leg dominance and body mass index were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to describe the association between physical examination data and the presence or absence of Jones fractures.

Results

From 2000 to 2014, among 162 professional football club players, 22 (13.6%; 21 Asians and one Caucasian) had a history of Jones fracture. Thirteen out of 22 (60%) had a Jones fracture in their non-dominant leg. The mean range of hip internal rotation (HIR) was restricted in players with a history of Jones fracture [25.9° ± 7.5°, mean ± standard deviation (SD)] compared to those without (40.4° ± 11.1°, P < 0.0001). Logistic regression analyses demonstrated that HIR limitation increased the risk of a Jones fracture (OR = 3.03, 95% CI 1.45–6.33, P = 0.003). Subgroup analysis using data prior to Jones fracture revealed a causal relationship, such that players with a restriction of HIR were at high risk of developing a Jones fracture [Crude OR (95% CI) = 6.66 (1.90–23.29), P = 0.003, Adjusted OR = 9.91 (2.28–43.10), P = 0.002]. In addition, right HIR range limitation increased the risks of developing a Jones fracture in the ipsilateral and the contralateral feet [OR = 3.11 (1.35–7.16) and 2.24 (1.22–4.12), respectively]. Similarly, left HIR range limitation increased the risks in the ipsilateral or the contralateral feet [OR (95% CI) = 4.88 (1.56–15.28) and 2.77 (1.08–7.08), respectively].

Conclusion

The restriction of HIR was associated with an increased risk of developing a Jones fracture. Since the HIR range is a modifiable factor, monitoring and improving the HIR range can lead to prevent reducing the occurrence of this fracture.

Level of evidence

III.

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Abbreviations

HIR:

Hip internal rotation

BMI:

Body mass index

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgements

The authors are grateful to Akira Komiyama, Nobuyasu Miyauchi and other athletic trainers for supporting our work. We also thank the members of The Jones Fracture Research Group for their insightful discussions.

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Authors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Yoshitomo Saita, Masashi Nagao, Takayuki Kawasaki, Yohei Kobayashi, Keiji Kobayashi, Hiroki Nakajima, Yuji Takazawa, Kazuo Kaneko & Hiroshi Ikeda

  2. FIFA Medical Centre of Excellence Tokyo, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Yoshitomo Saita & Hiroshi Ikeda

  3. Jones Fracture Research Group, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Yoshitomo Saita

Authors
  1. Yoshitomo Saita
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  2. Masashi Nagao
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  3. Takayuki Kawasaki
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  4. Yohei Kobayashi
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  5. Keiji Kobayashi
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  6. Hiroki Nakajima
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  7. Yuji Takazawa
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  8. Kazuo Kaneko
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  9. Hiroshi Ikeda
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Contributions

YS and MN were involved in study design, data interpretation, drafting the manuscript and revising the manuscript content. YS, MN, YK and KK conducted the study. YS, YK, KK, HN, YT, KK and HI collected the data. YS and athletic trainers described in acknowledgements performed physical examinations. YS, MN and TK analysed the data. All authors read and approved the final manuscript. YS and MN take responsibility for the integrity of the data analysis.

Corresponding author

Correspondence to Yoshitomo Saita.

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The author(s) declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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The author(s) received no financial support for the research, authorship and/or publication of this article.

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Ethical approval was obtained from institutional review board.

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Saita, Y., Nagao, M., Kawasaki, T. et al. Range limitation in hip internal rotation and fifth metatarsal stress fractures (Jones fracture) in professional football players. Knee Surg Sports Traumatol Arthrosc 26, 1943–1949 (2018). https://doi.org/10.1007/s00167-017-4552-4

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  • DOI: https://doi.org/10.1007/s00167-017-4552-4

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