The radiograph seen in Figure A demonstrates a metadiaphyseal fracture of the fifth metatarsal that involves the 4th-5th intermetatarsal joint, otherwise known as a Jones fracture. 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 reviews the presentation and treatment of fractures of the fifth metarsal. He states that internal fixation, usually with an intramedullary screw, will allow for more rapid return to sport than nonoperative management. The author cautions, however, that return to sport prior to radiographic union leads to higher rates of failure of fixation.
Illustration A shows an example of intramedullary screw fixation.
Answer 1: Female gender has not been associate with failure of fixation
Answer 2: Patient age has not been shown to affect outcomes with these fractures
Answer 4: No clinical difference has been shown with solid screw fixation and some advocate for use a solid screw given the increased strength
Answer 5: Increased rates of failure are seen with 3.5mm screws, not 4.5 mm screws
Dameron TB Jr. Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. J Am Acad Orthop Surg. 1995 Mar;3(2):110-114.
PMID:10790659 (Link to Abstract)