Jones Fracture Discussion

Laurie Grove8/24/2010

AIMS

A Jones fracture is a fracture of the fifth metatarsal of the foot at the proximal end. Patients who sustain a Jones fracture have pain over this area, swelling, and difficulty walking.

Why is this called a "Jones Fracture"?This injury was first described in 1902 by Sir Robert Jones in an article titled "Fractures of the Base of the First Metatarsal Bone by Indirect Violence." He included descriptions of six patients (one being himself) who sustained fractures in this area without a direct impact (his injury occurred while dancing). This article included fractures we now classify as avulsion fractures, stress fractures, and what we presently refer to as a Jones fracture.

Diagnosis A patient with a Jones fracture may not

realize that it is a fracture, and could mistake it for a sprain.

The diagnosis is made with general diagnostic x-rays. These need to be taken from anteroposterior, oblique, and lateral views. They should be made with the foot in full flexion.

Treatment Non-surgical Treatment

Until you are able to see a foot and ankle surgeon, the “R.I.C.E.” method of care should be performed:

Rest: Stay off the injured foot. Walking may cause further injury. Ice: Apply an ice pack to the injured area, placing a thin towel

between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

Compression: An elastic wrap should be used to control swelling. Elevation: The foot should be raised slightly above the level of

your heart to reduce swelling. If a Jones fracture is not significantly displaced, it can be treated

with a cast, splint or walking boot for four to eight weeks. Patients should not place weight on the foot until instructed by their doctor. Three-fourths of fractures treated like this should heal

When is Surgery Needed?If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

For both the acute Jones fracture and chronic stress fracture operative treatment with a screw is ideal. It is not necessary to open the skin with a large incision to fix the fracture at all. Use a tiny puncture in the skin, and then insert a small pin into the Metatarsal guided with a C-arm. Once the pin has been inserted across the fracture into the canal of the metatarsal, it is then easy to insert a screw into the shaft of the metatarsal to facilitate healing. The size and type of the screw are very important. Athletes are allowed to bear weight on the foot immediately following surgery in a boot, but limit impact loading of the foot, particularly twisting activities.

Prognosis If a Jones fracture fails to unite, it can become a chronic

condition. If this is the case, Podiatric Physicians will likely recommend that the patient spend more time in a cast, up to twenty weeks.

For several reasons, a Jones fracture often does not heal. The diaphyseal bone, where the fracture occurs, is an area of poor blood supply. In medical terms, it is a watershed area between two blood supplies. This makes healing difficult. In addition, there are various tendons, including the peroneus brevis and fibularis quartus, and two small muscles attached to the bone. These may pull the fracture apart and prevent healing.

 

Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

Peter Vorlat,1,2 Wim Achtergael,1 and Patrick Haentjens Department of Orthopaedics and Traumatology, University

Hospital of the Vrije Universiteit Brussel, Brussels, Belgium 2Department of Orthopaedics and Traumatology,

Academisch Ziekenhuis - V.U.B., Laarbeeklaan 101, 1090 Brussels, Belgium

Int’l Orthop. 2007 February; 31(1): 5–10. Published online 2006 May 23. doi:

10.1007/s00264-006-0116-9.

The purpose of this study was to identify those factors that influence the outcome after conservative treatment of undisplaced fractures of the fifth metatarsal. This was done with univariate (Univariate analysis explores each variable in a data set, separately) analyses and, for the first time, with regression analyses of day-to-day clinical practice. Thirty-eight patients were treated with plaster and periods of no weight bearing (NWB). Their mean age was 48 years. They were evaluated using analogue scales for pain and comfort, and with questions about cosmesis (restoring body esthetics) and wearing of shoes. Six patients sustained a Jones fracture and 32 a tuberosity avulsion fracture. The mean period of NWB was 17 days and of casting was 38 days. Three Jones fractures and all the avulsion fractures were healed at the end of treatment. After a mean of 490 days, the global ankle score was 82/100. Ten patients reported problems with shoes and nine reported cosmetic problems. The linear analogue scale for pain was 2.11/10 and for comfort 8.42/10. Gender, age, and fracture type did not affect outcome. The most significant predictor of poor functional outcome was longer NWB, which was strongly associated with worse global outcome, discomfort, and reported stiffness. NWB should be kept to a minimum for acute avulsions of the tuberosity of the fifth metatarsal.

A review of non-operative treatment of Jones' fracture Am Journal of Sports Medicine

Richard G. Zogby, MD Department of Orthopaedic Surgery, SUNY

Health Science Center at Syracuse, Syracuse, New York

Bruce E. Baker, MD Department of Orthopaedic Surgery, SUNY

Health Science Center at Syracuse, Syracuse, New York

classification into acute and chronic categories by several authors has been proposed and most agree with the relatively high incidence of non- union. Controversy exists concerning operative versus non-operative primary treatment especially in athletes. The purpose of this study was to determine if non- op erative treatment could be used effectively in treating these fractures. A retrospective study of nine patients with 10 Jones' fractures was completed. The cases were categorized as acute or chronic by clinical history and radiographic appearance. The average age was 23.6 years. There were eight males and one female. In this group, competitive athletes sustained chronic fractures, while acute fractures occurred in non-athletes.

Treatment consisted of a short leg nonweightbearing cast until radiographic and clinical healing occurred, followed by 6 weeks of limited activity.

Mean clinical and radiographic union of chronic fractures was 9.4 weeks; acute fractures, 22 weeks. All competitive athletes returned to their pre-injury level of competition at an average of 12 weeks following initiation of treatment. There was one refracture. Our data indicate that nonoperative treatment of early chronic or subacute fractures without intramedullary sclerosis can compare favorably with surgical treatment procedures reported in other studies in returning athletes to play postinjury. We suggest serious consideration be given to the method herein as a form of primary treatment of the early chronic Jones' fracture without intramedullary sclerosis.