Jones' Fractures and Related Fractures of the Proximal Fifth Metatarsal

Abstract

At least three fracture types occur in the proximal fifth metatarsal: the Jones' fracture, the proximal diaphysial stress fracture, and the tuberosity avulsion fracture. Each has distinct characteristics. The diaphysial stress fracture is commonly confused with the Jones' fracture, thereby obscuring vital differences in prognosis and treatment. Anatomical and biomechanical characteristics, as well as vascular studies of the proximal portion of the fifth metatarsal, are discussed in an attempt to better understand their diverse healing potentials. Guidelines for treatment are controversial, and must frequently be individualized. Although surgical intervention for certain proximal fifth metatarsal fracture types may speed recovery time, most fractures heal with immobilization. Treatment of displaced, intra-articular fractures, delayed unions, and nonunions usually requires operative methods.

Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

“…The Jones fracture initially was described by Sir Robert Jones in 1902 [7], and a review of his article showed both fracture types are included in his clinical cases and radiographs. More recent literature defines differences in diagnosis and prognosis between acute Jones and proximal diaphyseal stress fractures [11,[20][21][22]. A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation [11].…”

“…More recent literature defines differences in diagnosis and prognosis between acute Jones and proximal diaphyseal stress fractures [11,[20][21][22]. A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation [11]. The mechanism of injury is believed to be an abduction force applied to the forefoot with simultaneous ankle plantar flexion [3,17,19,22].…”

“…are distinguished by differences in anatomic location and natural history [4,11,14]. According to numerous authors, a Jones fracture can be treated with 6 to 8 weeks of nonweightbearing immobilization resulting in fair to good outcomes [4,6,9,11,14,16,20].…”

“…According to numerous authors, a Jones fracture can be treated with 6 to 8 weeks of nonweightbearing immobilization resulting in fair to good outcomes [4,6,9,11,14,16,20]. Operative treatment is selected if the patient is a high-performance athlete or nonoperative treatment fails [5,11,14].…”

“…According to numerous authors, a Jones fracture can be treated with 6 to 8 weeks of nonweightbearing immobilization resulting in fair to good outcomes [4,6,9,11,14,16,20]. Operative treatment is selected if the patient is a high-performance athlete or nonoperative treatment fails [5,11,14]. In contrast, a proximal diaphyseal fifth metatarsal fracture may have a protracted healing time of as much as 21 months [4] and nonunion can develop in as much as 25% of nonoperatively treated cases [4,8].…”