by Doug Bartels
A 24-year-old male presents to the emergency department one hour after suffering a forefoot adduction ankle injury while playing flag football. The lateral side of his right foot is painful and he is having a hard time walking due to the pain. On exam, the base of his 5th metatarsal is very tender to palpation and there is associated swelling and ecchymosis. X-ray of the foot are ordered. What do you see?
The x-rays show a fracture through the proximal portion of the 5th metatarsal which is commonly referred to as a Jones’ fracture. The most widely accepted definition of a Jones’ fracture as described by Torg et al. is a fracture of the proximal part of the diaphysis distal to the tuberosity of the 5th metatarsal. Why do we care? What makes this fracture unique, compared to all other metatarsal fractures, is that it exists in a vascular watershed region. Because of this, fractures at this site are at increased risk of delayed union or complete non-union.
HOW DO WE HANDLE THESE FRACTURES?
This is the million dollar question. Both conservative and surgical options for management of Jones’ fractures exist. Leaving Jones’ fracture to heal on their own has been shown to result in suboptimal outcomes including non-union and increased time to bone union; however, surgical intervention has proven to have issues as well with a far from perfect track record for healing. So which is better?
WHAT DO THESE RESULTS MEAN?
This systematic review found that surgical intervention of Jones’ fractures leads to lower non-union rates, faster time to union, and faster return to sports and activity when compared to patients managed conservatively. So, take a knife to everyone? It is still important to analyze each patient on a case-by-case basis to determine if comorbidities or additional patient factors would make surgical intervention a suboptimal choice.