| Jones fracture | |
|---|---|
| Other names | Fracture of themetaphysis of the fifth metatarsal[1] |
 | |
| Jones fracture as seen onXray | |
| Specialty | Emergency medicine,orthopedics,podiatry |
| Symptoms | Pain near the midportion of the foot on the outside, bruising[2][3] |
| Usual onset | Sudden[4] |
| Duration | 6-12 weeks to heal[5] |
| Causes | Bending the foot inwards when thetoes are pointed[6] |
| Diagnostic method | Based on symptoms,X-rays[3] |
| Differential diagnosis | Pseudo-Jones fracture, normalgrowth plate[3][7] |
| Treatment | Non-weight bearing,cast, surgery[5] |
AJones fracture is abroken bone in a specific part of thefifth metatarsal of thefoot between thebase andmiddle part .[8] In general, fifth metatarsal fractures heal readily, but a Jones fracture must be recognized and accurately diagnosed because of its higher rate of delayed healing ornonunion.[4] It results in pain near the midportion of the foot on the outside.[2] There may also be bruising and difficulty walking.[3] Onset is generally sudden.[4]
The fracture typically occurs when thetoes are pointed and the footbends inwards.[6][2] This movement may occur when changing direction while the heel is off the ground such in dancing, tennis, or basketball.[9][10] Diagnosis is generally suspected based on symptoms and confirmed withX-rays.[3]
Initial treatment is typically in acast, without bearing weight on it, for at least six weeks.[5] If, after this period of time, healing has not occurred, a further six weeks of casting may be recommended.[5] Due to poor blood supply in this area, the break sometimes does not heal and surgery is required.[3] In athletes, or if the pieces of bone are separated, surgery may be considered sooner.[5][8] The fracture was first described in 1902 byorthopedic surgeonRobert Jones, who sustained the injury while dancing.[11][4]
A person with a Jones fracture may not realize that a fracture has occurred. Diagnosis includes the palpation of an intactfibularis brevis tendon, and demonstration of local tenderness distal to thetuberosity of the fifth metatarsal, and localized over the shaft of the proximal metatarsal.
Diagnostic X-rays include anteroposterior, oblique, and lateral views and should be made with the foot in full flexion.[citation needed]
Other proximal fifth metatarsal fractures exist, although they are not as problematic as a Jones fracture. If the fracture enters theintermetatarsal joint, it is a Jones fracture. If, however, it enters thetarsometatarsal joint, then it is likely anavulsion fracture caused by pull from thefibularis brevis tendon. An avulsion fracture at the base of the fifth metatarsal is sometimes called a "dancer's fracture" or a "pseudo Jones fracture", and usually responds readily to non-operative treatment.[18]The X-ray appearance of the developmental "apophysis" in this area may have some resemblance of a fracture, but is not a fracture; it is the secondaryossification center of the metatarsal bone. It is a normal finding that occurs at this site in adolescents.[19] If an injury to that area has occurred, the physician is often able to interpret certain radiographic clues to make the differentiation. An avulsion fracture at this location is typically extra-articular and oriented transversally as compared to the longitudinal orientation of an unfused apophysis.[19]
Initial treatment is typically in acast, without any weight being placed on it, for at least six weeks.[5] If after this period of time healing has not occurred a further six weeks of casting may be recommended.[5] Up to half, however, may not heal after casting.[2]
In athletes or if the pieces of bone are separated by more than 2 mm surgery may be considered.[5][8] In a study of all players who entered theNFL Scouting Combine from 2009 to 2015, the incidence of Jones fracture was 3.2% and all had received surgery to repair the fracture with a metal screw.[20] For persons who are not athletes, surgery might not be recommended unless healing does not occur after a trial of cast treatment.[5]
For several reasons, a Jones fracture may not unite. The diaphyseal bone (zone II), where the fracture occurs, is an area of potentially poor blood supply, existing in a watershed area between two blood supplies. This may compromise healing. In addition, there are various tendons, including the fibularis brevis and fibularis tertius, and two small muscles attached to the bone. These may pull the fracture apart and prevent healing.[citation needed]
Zones I and III have been associated with relatively guaranteed union and this union has taken place with only limited restriction of activity combined with early immobilization. On the other hand, zone II has been associated with either delayed or non-union and, consequently, it has been generally agreed that fractures in this area should be considered for some form of internal immobilization, such as internal screw fixation.[citation needed]
These zones can be identified anatomically and on x-ray adding to the clinical usefulness of this classification.[21]Surgical intervention is not, by itself, a guarantee of cure and has its own complication rate. Other reviews of the literature have concluded that conservative, non-operative, treatment is an acceptable option for the non-athlete.[22]
