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Clinical Summary

Patients complain of pain, swelling, decreased range of motion, and tenderness over the lateral aspect of the midfoot. Fractures of the 5th metatarsal base have been generically referred to as Jones fractures. However, acute fractures can be divided into two types depending on their anatomic location; treatment is determined by this delineation.

The classic Jones fracture is a transverse fracture of the 5th metatarsal at the metadiaphyseal-diaphyseal junction, just distal to the 4th and 5th intermetatarsal joint. It occurs when a force is applied to a plantar flexed and inverted foot. This is not to be confused with an avulsion fracture of the 5th metatarsal base, resulting from sudden foot inversion. The avulsion injury is caused by traction on the lateral cord of the plantar fascia.

FIGURE 11.103

Jones Fracture. This patient sustained an injury of the fifth metatarsal and presented with pain and swelling over this site. His radiograph revealed a fracture. (Photo contributor: Cathleen M. Vossler, MD.)

FIGURE 11.104

Fifth Metatarsal Base Fractures. This illustration depicts an avulsion fracture (A) and a classic Jones fracture (B).

Management and Disposition

The patient with a Jones fracture should be discharged in a posterior splint and crutches and be non–weight bearing for 6 to 8 weeks. Surgical treatment is sometimes required since there is a risk of nonunion.

The avulsion fracture usually heals rapidly and seldom leads to permanent disability. This patient can be discharged in a hard-soled shoe or walking cast for 2 to 3 weeks and can bear weight as tolerated. A significantly displaced fracture may require operative intervention. Both types of patients should be referred to a musculoskeletal specialist as an outpatient.

Pearls

  1. The original description was by Sir Robert Jones, who personally sustained this injury while dancing. The avulsion fracture is sometimes referred to as a dancer’s fracture.

  2. The classic Jones fracture has a high incidence of delayed healing and nonunion.

FIGURE 11.105

Jones Fracture. Radiograph with typical appearance for a diaphyseal fracture of the fifth metatarsal base. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 11.106

Fifth Metatarsal Avulsion Fracture. Radiograph illustrating an avulsion-type fracture of the fifth metatarsal base. (Photo contributor: Alan B. Storrow, MD.)

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