Jones Fracture of the fifth metatarsal – what to know.

A Jones fracture is a break in the fifth metatarsal bone of the foot. This type of fracture can be difficult to heal. In this blog post, we will discuss Jones fracture management and when to fix it surgically.

What is a Jones fracture?

A Jones fracture is a break in the fifth metatarsal bone of the foot at a very specific location. This type of fracture can be difficult to treat because it just so happens to occur at a location in the metatarsal bone where the blood flow is reduced. This is called the “watershed” zone of the metatarsal and can predispose the healing process to a delay-union (takes longer than expected to heal) or a non-union (doesn’t heal at all).

The metatarsals are the next layer of bones that connects with all the toes. Injuries can occur in a variety of ways including overuse (like a stress fracture), twisting the foot, direct trauma (car driving over the foot), and landing incorrectly.

This is an extremely common sports injury and is common amongst NFL athletes. The mechanism of injury involves landing on the outside part of the foot causing the front of the foot to bend the break occurs at the base of the 5th metatarsal. Pain will occur at the site of the injury and the patient will have difficulty walking. After the injury, the usual signs of trauma will develop like swelling, bruising, and redness.

How is it diagnosed and treated?

The diagnosis of a Jones fracture is made with a combination of medical history, physical examination, and imaging studies. X-rays are typically the first line of imaging and all that is necessary so an MRI and CT scan is usually not necessary unless other injuries are suspected. Usually, advanced imaging studies are ordered when a Jones fracture either goes undiagnosed and presents as a delayed or non-union, or if the fracture is treated non-surgically or surgically and delayed healing is encountered. A CT scan is a more accurate way to assess the extent of healing compared to a conventional x-ray.

Once the diagnosis is made, treatment options can be discussed. Treatment options for a Jones fracture include conservative (non-surgical) or surgical management.

Non-surgical management includes rest, ice, elevation, and immobilization in a boot or cast. This option is typically chosen for patients who are not as active and requires strict non-weight bearing either in a fiberglass cast or removable boot until some healing is seen on the x-ray.

Surgical treatment is recommended in most cases especially for the active/athletic population to minimize complications associated with decreased blood flow at the side of the fracture. Surgery is performed under anesthesia at the hospital or surgical center and the patient goes home the same day. Usually, the procedure takes no more than 45 minutes.

In most cases, a single screw can be applied through a minimally invasive approach. This is called an intramedullary screw because it sits inside the inner canal of the bone to keep the fracture stable. A small incision is placed just beyond the bone and using orthopedic fixation techniques and intra-operative x-ray, a screw can be inserted.

Once the screw is inserted, a few sutures are placed to close the small incision. A splint is applied to the leg and the patient needs to remain non-weight bearing (crutches, knee scooter, iWalk, etc…). At the 2-week post-op appointment sutures are removed and updated imaging is obtained. If everything appears stable, sometimes protected weight bearing can be initiated in a CAM walker. Physical therapy is commenced once the sutures are removed and the patient is transitioned into the CAM boot.

Return to baseline athletics should only be considered once the bone appears fully healed on an x-ray which is usually a few months after the injury.

What are the risks associated with a Jones fracture, and how can they be minimized?

The biggest risk associated with a Jones fracture is a delayed or non-union. This can be minimized by undergoing surgery to have the fracture stabilized with orthopedic hardware. I will always recommend surgery to my active/athletic population.

Optimizing bone metabolism is important. Vitamin D supplementation is encouraged and if a patient has been significantly deficient in the past checking the vitamin D level in the blood could be considered. If a patient smokes, cessation is encouraged as this significantly impairs bone healing.

Jones fracture surgery is a common procedure with high success rates. If you are faced with this injury, be sure to consult with your doctor about the best course of action for you. Surgery may be the best option to minimize healing complications and get you back on the field as soon as possible.

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