Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Jones Fracture

Basics
Description
  • Fracture of the base of the 5th metatarsal of the foot
    • Injuries may be acute or stress fractures.
  • Classification is by location of the fracture.
    • Tuberosity avulsion fracture: No involvement of the 4th to 5th intermetatarsal joint
    • True Jones fracture: Proximal metaphyseal fracture with involvement of the 4th to 5th intermetatarsal joint up to the metaphyseal-diaphyseal junction
    • Diaphyseal fracture (pseudo-Jones fracture): At the proximal diaphysis, distal to the tuberosity of the peroneus tertius insertion
General Prevention
Early radiographs for athletes complaining of lateral foot pain so that treatment measures can be initiated to decrease prolonged symptoms.
 
Epidemiology
  • Common in athletes
  • Metatarsal fractures occur at all ages (mean age, 42 years).
  • Occurs more often in females than males
  • 63% of all metatarsal fractures involve the 5th metatarsal.
Incidence
1.8% of professional football players sustain a Jones fracture.
 
Risk Factors
  • Athletics
  • Falls
  • Osteoporosis is a risk factor for foot fractures
Etiology
  • Avulsion fracture: Inversion or internal rotation injury of the foot
  • Jones or diaphyseal fractures: Indirect trauma (inversion or internal rotation injuries) or direct trauma, such as dropping a heavy object on the foot
Diagnosis
Signs and Symptoms
Pain and swelling along the lateral border of the foot occur with point tenderness at the base of the 5th metatarsal.
 
Physical Exam
  • Pain over the lateral forefoot with palpation and weightbearing
  • Swelling and redness also common
Tests
Imaging
Plain, AP, lateral, and oblique radiographs of the foot are obtained to determine the level and displacement of the fracture.
 
Pathological Findings
The watershed blood supply to the metaphyseal-diaphyseal junction makes fractures in this area more susceptible to nonunion and requires more aggressive treatment of the Jones fracture than do other metatarsal fractures.
 
Differential Diagnosis
  • Lisfranc injury (dislocation of tarsometatarsal joints)
  • Stress fracture of the 5th metatarsal diaphysis
Treatment
General Measures
  • Treatment varies by fracture type.
    • Tuberosity avulsion:
      • Symptomatic management involves weightbearing as tolerated with a hard-soled shoe, cast, or splint, even with considerable displacement (>1 cm).
      • Clinical union often occurs by 3 weeks.
      • Nonunion is rarely symptomatic; if problematic, resect the fragment and reattach the peroneus brevis tendon.
    • Diaphyseal fracture:
      • The patient is nonweightbearing in a below-the-knee cast until radiographic union occurs (usually 8 weeks), followed by 6 weeks of limited activity.
    • Jones fracture:
      • Most are treated with a nonweightbearing below-the-knee cast for 4-6 weeks.
      • Competitive athletes may undergo percutaneous screw fixation with weightbearing after 2 weeks and may return to sports after pain and tenderness have resolved (8 weeks).
Activity
Activity is as-tolerated with the previously mentioned external supports, except for diaphyseal fractures, for which patients should remain nonweightbearing for 6-8 weeks.
 
Special Therapy
Physical Therapy
Rarely indicated
 
Surgery
  • Diaphyseal fractures:
    • May be treated with percutaneous placement of a malleolar screw for earlier return to activity
  • Jones fracture:
    • Screw fixation for Jones fractures in competitive athletes
    • A cannulated screw can be placed percutaneously.
  • Avulsion fracture
    • Symptomatic nonunion may be treated with excision of the fragment and reattachment of the peroneus brevis tendon.
Follow-up
Prognosis
  • The prognosis is excellent for avulsion fractures.
  • Jones fractures treated nonoperatively have approximately a 40% chance of not healing.
  • Treatment of Jones fractures with intramedullary fixation is thought to result in a higher rate of healing and earlier return to function for athletes.
Complications
  • Nonunion of fracture
  • Recurrent fractures are more common in highly competitive athletes.
  • Returning to sport before full healing is thought to increase the rate of nonunion even with surgical treatment.
Patient Monitoring
  • Patients are followed at 1-month intervals until the fracture heals and they return to full weightbearing.
  • Delayed union occurs when the healing at the fracture site has not occurred by 6-8 weeks.
  • The fracture is judged to be a nonunion if no evidence of additional healing is noted and pain is present at the fracture site.
Miscellaneous
Codes
ICD9-CM
825.25 Metatarsal fracture
 
Patient Teaching
  • Stress the importance of following weight limitations to prevent nonunion and delay in return to normal activities.
  • Stress to athletes that training should not begin after a Jones fractures until healing can be seen radiographically.
Activity
Patients with stress injuries should resume activity slowly.
 
Prevention
Athletes should monitor training activity to avoid repetitive stress injury.
 
FAQ
Q: Is a cast or splint needed for a fracture of the base of the 5th metatarsal?
A: The need for immobilization depends on the fracture type. Avulsion fractures require only symptomatic treatment. A splint may be used if the patient has a lot of pain. Jones fractures should be treated with immobilization; consideration should be given to intramedullary fixation.

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