BACKGROUND: There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures. HYPOTHESIS: Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment. STUDY DESIGN: Randomized controlled clinical trial; level of evidence, 1. METHODS: Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient. RESULTS: Mean follow-up was 25.3 months (range 15 to 42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with p < 0.001. CONCLUSION: There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.

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