Nonoperative Treatment of Stress Fractures of the Proximal Shaft of the Fifth Metatarsal (Jones' Fracture)

Abstract

Early operative fixation of stress fractures of the proximal diaphysis of the fifth metatarsal has been advocated because of the high potential for delayed union, nonunion, and refracture. Case reports are given of three athletes with stress fractures of the proximal shaft of the fifth metatarsal who were treated nonoperatively and who returned to early athletic participation without recurrent symptoms or refracture. Treatment of this injury should be individualized because of the potential for nonunion and the ability of this fracture to heal.

Fractures of Proximal Portion of Fifth Metatarsal Bone: Anatomic and Imaging Evidence of a Pathogenesis of Avulsion of the Plantar Aponeurosis and the Short Peroneal Muscle Tendon

“…Furthermore, the fracture needs to be distinguished from apophyseal distraction fractures in the immature skeleton, a normal or injured sesamoid or vesalian bone, or injuries to the tarsometatarsal complex (3,14). Thus, it is important to recognize a fracture and distinguish among the different fracture types to avoid the potential clinical complications associated with delayed union, nonunion, or repeat fracture after union if the appropriate treatment is delayed or not rendered (1,11,14,28,29).…”

Fractures of the fifth metatarsal in basketball players

“…The prognosis is even worse when a delayed union or nonunion is involved, or the fractured metatarsal shows radiologic signs of stress phenomena. When these changes, which are interpreted by some to be the result of long-standing fracture with a delayed union or nonunion [27,28], are present, more aggressive treatment may be undertaken [8,23,[25][26][27][28], particularly for young and athletic patients [6,11,15,17,18,22,27,28], as is often the case [1,[13][14][15]25]. When these changes, which are interpreted by some to be the result of long-standing fracture with a delayed union or nonunion [27,28], are present, more aggressive treatment may be undertaken [8,23,[25][26][27][28], particularly for young and athletic patients [6,11,15,17,18,22,27,28], as is often the case [1,[13][14][15]25].…”

Long-term results after fracture of the fifth metatarsal

“…Fractures located just below the articulation between the fifth and the fourth metatarsal (Jones’ fracture) are often complicated with delayed or non‐union. Periosteal reaction or medullary sclerosis are radiographic parameters of these complications that consequently influence the choice of treatment [1, 3, 5, 7–17].…”

“…Some authors suggest operation for the young active patient who wants a quick return to former levels of activity. Operative treatment is recommended for fractures with evidence of delayed or non‐union [1, 8, 11–13, 15, 18, 19]. It is generally agreed that surgery should be performed by a medullary screw or bone grafting [1, 2, 5, 11, 12, 18], and that conservative treatment should include a period of non‐weightbearing immobilization until healing takes place [7, 8, 13, 16, 17, 19].…”