Stress fracture of the fifth metatarsal

DeLee, Jesse C.; Evans, Jeff; Julian, JoAnne

doi:10.1177/036354658301100513

Cited by 306 publications

(312 citation statements)

References 9 publications

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“…None of the patients in the nonoperative treatment group had fracture site sclerosis or medullary canal obliteration, both considered poor prognostic factors for progression to union [20]. No difference was noted in either return to sport time or fracture union time between the Jones and proximal diaphyseal groups; the observation that nonoperative treatment outcomes for Jones and proximal fifth metatarsal base fractures were not different is in contrast to previous studies [4,5,23] that suggest poor results for nonoperative treatment of proximal diaphyseal fractures. Based on our findings, we recommend nonoperative treatment as initial management for Jones and proximal fifth metatarsal base fractures, provided the patient and physician are in agreement and the patient accepts a long period of nonweightbearing.…”

Section: Discussioncontrasting

confidence: 57%

“…Operative treatment for Jones and proximal diaphyseal fractures of the fifth metatarsal usually is recommended in an athletic population [2,5,16,20]. Shorter recovery time, earlier return to sport, and a higher union rate are proposed advantages of operative treatment over nonoperative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

Chuckpaiwong

Queen

Easley

et al. 2008

Clin Orthop Relat Res

143

146

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Jones and proximal diaphyseal fractures of the fifth metatarsal are in close anatomic proximity and often are difficult to differentiate. We determined whether it is necessary to differentiate between these two diagnoses. Retrospectively, the two diagnoses were identified radiographically using an accepted classification scheme. Initial management is nonoperative; however, intramedullary screw fixation is performed for competitive athletes, or others with displaced fractures, or delayed union or nonunion. Outcomes were analyzed using Student's t tests, whereas nominal data were analyzed using chi square tests. Thirty-two Jones fractures and 29 proximal diaphyseal fractures were identified. All fractures healed between 4.8 and 9.8 months with a 78% to 82% patient satisfaction rate. Regardless of treatment, the clinical outcomes were not different between the two fracture locations. Shorter return to sport time was observed in operatively treated patients. Operatively treated patients with fracture site sclerosis or medullary canal obliteration on radiographs had lower satisfaction and higher complication rates than patients without these changes. Based on our findings, we do not find a reason to distinguish between fractures of the fifth metatarsal in these two locations. We suggest referring to fifth metatarsal base fractures (excluding avulsions) as Jones fractures.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

Chuckpaiwong

Queen

Easley

et al. 2008

Clin Orthop Relat Res

143

146

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“…Most studies are focused on the second and the fifth metatarsal bones because they are prone to both fracture and stress fracture in active sportsmen. 10,11 Furthermore all these studies were performed either in dry bones or cadavers. …”

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confidence: 99%

Bone mineral density of the metatarsal bones and the first ray in male sportsmen

Sindel¹

2010

Anatomy

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Objectives: Measurement of bone mineral density (BMD) is used frequently for assessment of bone strength and prediction of fracture risk in clinical settings. Among the bones in feet, fractures are seen often in second and third metatarsal of active sportsmen. This study was carried out to evaluate the reasons of increased risk of stress fractures in feet of active sportsmen by determining the BMD in overused regions. Methods:Two groups were examined in the present study. First group included males who were not sportsmen while the second and third groups were formed by professional male soccer and basketball players respectively. Areal bone density was measured by dual energy x-ray absorptiometry and the BMD values were calculated by using the rectangular region of interest in metatarsals. Results:The first metatarsal had the highest BMD in all groups (P<0.05). The fifth metatarsal had the second highest BMD value. Similarly subchondral measurement of the BMD revealed that the first tarsometatarsal joint were significantly denser than the first metatarsophalangeal joint (P<0.05). BMDs of all metatarsals in non-sportsmen group were significantly lower than BMDs of sportsmen groups and there were no noticable differences of BMD between soccer and basketball players. Conclusion:Because the degree of activity-induced enhancement of bone mineralization were similar in all metatarsals of active sportsmen, increased incidence of fractures in second and third metatarsals must be partly due to anatomical positioning of these bones. Hence appropriate shoe designs which have support for second and third metatarsals may decrease fracture incidence. Most studies are focused on the second and the fifth metatarsal bones because they are prone to both fracture and stress fracture in active sportsmen. 10,11 Furthermore all these studies were performed either in dry bones or cadavers. 12-14The resistance of other metatarsal bones to fracture might be due to differences in BMDs of these bones. To the best of our knowledge, there is no study examining the changes in BMDs of the metatarsal bones in healthy subjects. Hence the goal of our study was to examine the changes in metatarsal bones of active sportsmen which may further clarify the reasons leading to fractures in second and third metatarsal bones in active sportsmen. Materials and Methods SubjectsTwo groups were examined in this study. The control subjects were 18 male students who had not done any sports regularly. The sportsmen groups were consisted of 20 professional soccer and 17 basketball players ( Table 1). All the subjects were meticulously examined by a physiatrist. None of them had joint problems and had undergone an orthopedic surgery, and they had not used any drugs affecting bone metabolism. The study was approved by the Ethical Committee of the Medical Faculty, University of Akdeniz. All the participants were volunteers (≥ 18 years old) and had given a written consent. DXA measurementAreal bone density was measured using a DXA tion, we used the Mann-Wh...

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“…Son múltiples los factores que pueden contribuir al desarrollo de las fracturas por estrés incluyendo factores sistémicos, factores anatómicos y factores mecánicos 20 . El factor mecánico no está claro, pero se cree que es debido a que un músculo crea una fuerza localizada que supera la capacidad de tensión del hueso 18 .…”

Section: Mecanismo De Lesiónunclassified

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

López

2018

Rev. Int. Cienc. Podol.

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Resumen. La fractura de Jones se define como una fractura transversal localizada en la unión de la diáfisis con la metáfisis proximal en el quinto metatarsiano y es una de las lesiones más comunes que aparecen en el pie. Es una zona pobremente vascularizada, lo que conlleva altas tasas de no unión de la fractura. Se diagnostica con un exploración clínica, asociada a pruebas radiológicas, siendo necesarias tres proyecciones: lateral, antero-posterior y una oblicua de 45º. Hay distintas clasificaciones como son la de Torg et al. y Dameron et al., que nos ayudan a establecer un tratamiento, en función de la localización de la fractura y su evolución radiológica. El objetivo de este trabajo es realizar una revisión en la literatura científica para valorar las diferencias en los resultados entre el tratamiento quirúrgico y tratamiento conservador, en relación al tiempo de unión ósea y las posibles complicaciones, determinando así cual es el tratamiento óptimo para estas fracturas. Se llega a la conclusión de que el tratamiento conservador es una opción viable, pero conlleva mayores tasas de no unión y mayor tiempo de retorno a la actividad física que el tratamiento quirúrgico, aunque este puede llevar a una serie de complicaciones tales como la lesión del nervio sural o una posible fractura iatrogénica del metatarsiano. El tratamiento quirúrgico, que consiste mediante la fijación con un tornillo intramedular, tiene menor tiempo de reincorporación a la actividad habitual y mayores tasas de consolidación ósea por lo que será de primera elección en deportistas. Palabras clave: fractura de jones; tratamiento quirúrgico; tratamiento conservador.[en] Jones Fracture. Surgical treatment or conservative treatment?Abstract. Jones' fracture is defined as a transverse fracture located at the junction of the diaphysis with the proximal metaphysis in the fifth metatarsal and is one of the most common lesions that appear in the foot. It's a poorly vascularized area, which leads to high rates of non-union of the fractures. It is diagnosed with a clinical examination, associated with radiological tests, three projections are necessary: lateral, antero-posterior and an oblique of 45º. There are different classifications such as Torg et al. and Dameron et al., which help us to establish a treatment, depending on the location of the fracture and its radiological evolution. The objective of this study is to perform a review in the scientific literature to evaluate the differences in the results between surgical treatment and conservative treatment, in relation to the time of union and the possible complications, thus determining which is the optimal treatment for these fractures. We conclude that conservative treatment is a viable option, but it leads to higher rates of non-union and greater time to return to physical activity than surgical treatment, although this may lead to a series of complications such as injury Sural nerve or a possible iatrogenic fracture of the metatarsal. The surgical treatment, which consists of the fixation wi...

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Stress fracture of the fifth metatarsal

Cited by 306 publications

References 9 publications

Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal

Bone mineral density of the metatarsal bones and the first ray in male sportsmen

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

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