Review Question - QID 4528

The radiograph shows a base of 5th metatarsal avulsion fracture, which is initially treated with protected weight-bearing and gradual return to activity as pain allows.

Identifying the difference between "true" Jones fractures and base of 5th metatarsal avulsion fractures is important, as healing rates without surgery are much higher for those fractures proximal to the metadiaphyseal junction. While Jones fractures enter the intermetatarsal joint, avulsion fracture enter the tarsometatarsal joint. Even in the elite athelete as described above, non-surgical management with protected weight-bearing is the initial management of choice. If the patient described above had a more distal fracture located in the watershed region of the metaphyseal-diaphyseal junction, intramedullary screw fixation would be the more appropriate option.

Porter et al. review the results of 23 athletes (24 feet) who had a Jones fracture fixed with a 4.5mm cannulated screw. Clinical healing was seen in 100% of the cases with an average return to play time of 7.5 weeks.

Mindrebo et al. review the results of 9 patients with a Jones fracture who were treated with percutaneous intramedullary screw fixation. All patients achieved clinical and radiographic union with an average reterun to full competition at 8.5 weeks.

Shahid et al. compared the outcome of avulsion fractures treated with a short leg walking cast versus a CAM boot and found quicker healing and return to activity with WBAT in a CAM boot, supporting non-operative treatment of this fracture.

Figure A shows a non-displaced base of fifth metatarsal avulsion fracture. Contrast this to illustration A, which represents a "true" Jones fracture at the metadiaphyseal junction which enters the intermetatarsal joint.

Incorrect Answers:
Answer 1: Immediate return to competitive activity is not recommended.
Answer 2: This surgical technique has not been described for her fracture.
Answer 3: Non-weight-bearing would be an unnecessary limitation in her activity.
Answer 4: This would be the appropriate management of a "true" Jones fracture.