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Musculoskeletal System ORGAN SYSTEMS

Jones fracture

Introduction

Fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, without joint involvement.

  • M/severe proximal 5th metatarsal fracture (Zone II)
    • 1.5 cm distal to the styloid of the 5th metatarsal

History

Robert Jones described the fracture of the fifth metatarsal which bears his name in the Annals of Surgery in 1902. In his paper, Jones describes the fracture in a series of 6 patients, the first of which was himself. He had injured his foot while dancing several months earlier, and had thought the injury to be to a tendon in the foot. He examined himself the day after the injury, and found that the tendon was intact, but he could not find definite evidence of bony injury. He asked a colleague, Dr. David Morgan, to X-ray his foot, and a fracture above the base of the fifth metatarsal was found. The finding of similar fractures in several patients after his own prompted him to write about it. He also noted that the fracture was not caused by direct trauma to the bone, as had always been written before, but by a cross-strain being applied to the bone.

382px-robert_jones_28surgeon29
Sir Robert Jones, 1st Baronet, KBE, CB, TD, FRCS (1857 – 1933) was a Welsh orthopaedic surgeon who helped to establish the modern specialty of orthopaedic surgery in Britain. He was an early proponent of the use of radiography in orthopaedics, and described the eponymous Jones fracture.

Classification

Lawrence and Botte’s classification of proximal 5th metatarsal fractures (Zone 1, 2 and 3):

jones-fracture-lawrence-and-botte-5th-mt-zones
Lawrence and Botte’s Classification of Proximal Fifth Metatarsal Fractures (Zone 1, 2 and 3) | Dr Mike Cadogan. (2019) Jones Fracture • LITFL Medical Blog • Medical Eponym Library. Retrieved April 16, 2019, from https://litfl.com/jones-fracture/
  • Zone 1: Tuberosity avulsion fracture, with/without involvement of the tarsometatarsal articulation.
    • Caused by forces by the peroneus brevis tendon or the lateral band of the plantar fascia during foot inversion.
  • Zone 2: Jones fracture; metaphysis-diaphysis junction fracture, which extend into the fourth-fifth intermetatarsal facet.
    • Caused by forced forefoot adduction with the hindfoot in plantar flexion.
  • Zone 3: Diaphyseal stress fracture; proximal diaphyseal fractures, distal to the fourth and fifth metatarsal base articulation.
    • Caused by acute excessive bearing of the region or chronic overloading as in stress fractures

Aetiology

Repetitive weight-bearing and pivoting on the involved foot.

  • Typically occurs when the toes are pointed and the foot bends inwards.
    • May occur when changing direction while the heel is off the ground such in dancing, tennis, or basketball

Clinical features

A person with a Jones fracture may not realize that a fracture has occurred.

Examination:

  • Intact peroneus brevis tendon
  • Local tenderness distal to the tuberosity of the 5th metatarsal, and localized over the diaphysis of the proximal metatarsal.
  • Normal bony crepitus

Diagnosis

Imaging

X-ray:

460px-cropped_version_of_jonesfracture
Jones fracture as seen on X-ray | Mdscottis – CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=34795057

Differential diagnosis

Other proximal 5th metatarsal fractures


Management

Nonweightbearing cast (6 weeks) (75% heal)

  • If healing has not occurred, further 6 weeks of casting is recommended
a-foot-support-for-a-jones-fracture
Treatment typically involves wearing a non-weight-bearing cast to support the foot for about 6 to 8 weeks. | Jones fracture: Causes, symptoms, and treatment. Retrieved April 16, 2019, from https://www.medicalnewstoday.com/articles/315039.php

Surgical management:

  • Acute fractures not healed by casting: Intramedullary screw compression
  • Chronic or fatigue fractures: Intramedullary compression screw fixation or open reduction and bone grafting (using corticocancellous bone graft)
  • Indications:
    • Athletes
    • Disaplaced fracture > 2mm
    • Healing does not occur after 12 weeks of casting

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