Review Question - QID 3988

The radiograph shows a base of 5th metatarsal Jones fracture (Zone 2), which should be initially treated in older, recreational athletes, with non-weight-bearing in a short leg cast.

The Jones fracture is an intra-articular fracture with extension into the 4th-5th tarsometatarsal joint. The fracture is the result of an inversion injury that causes a deforming force to occur between the insertions of the peroneus tertius and the peroneus brevis tendons. Non-displaced Jones fractures, in non-elite athletes, can be treated initially with non-weightbearing in a short cast for 6 weeks. A Jones fracture in a high performance athlete is a relative indication for operative intervention, however increased rates of failure are seen if the athlete returns to athletic participation prior to radiographic union.

Dameron et al reviewed the presentation and treatment of fractures of the fifth metatarsal. They state that internal fixation, usually with an intramedullary screw, will allow for more rapid return to sport than nonoperative management. However, the authors caution that return to sport prior to radiographic union leads to higher rates of failure of fixation.

Figure A shows a non-displaced fracture in Zone 2 of the base of 5th metatarsal.

Incorrect Answers:
Answers 1: Intramedullary cannulated screw fixation is usually reserved for high functioning patients that desire early union at the risk of surgical complications, or those that have failed conservative treatments.
Answer 2: Immediate weight bearing in supportive shows is recommend for Zone 1 fractures.
Answer 4: Percutaneous Kirschner wire fixation are not supported.
Answer 5: Open reduction and internal fixation with tubular plates are used with long fracture lines extending into Zone 3 or multifragmentary diaphyseal fractures of the fifth metatarsal.