Clapper et al 5 reported average time to healing of 21 weeks and a 28% nonunion rate from a series of 25 patients with a true acute Jones fracture. Nonoperative treatment in a nonweight-bearing short leg cast has been the traditional treatment 4 and is still widely practiced. Treatment for these fractures is controversial. Postoperatively, I keep these patients nonweight bearing for the first 2 to 3 weeks in a splint, and then advance to protected weight bearing in a cast or boot until 6 weeks after surgery.Ī true Jones fracture is an acute injury that occurs in Zone II of the fifth metatarsal base (Figure 36-2). I expose the fracture through a longitudinal incision centered on the dorsal aspect of the tuberosity and place the screw percutaneously. A partially threaded cannulated 4.0-mm screw with a washer works well. For these relatively uncommon variants, I use a small fragment screw placed obliquely through the tuberosity and across the medial cortex of the proximal fifth metatarsal in lag fashion. Computed tomography is very helpful in evaluating the extent of the joint involvement and displacement if plain films are equivocal. If substantial joint displacement is noted (more than 2 to 3 mm), I will consider open reduction and internal fixation. ![]() Occasionally, I will see a patient with a large Zone I tuberosity avulsion that involves a significant amount of the joint surface. I do not routinely obtain follow-up radiographs because fibrous unions are common, are usually asymptomatic, and do not change my treatment recommendations. Patients are encouraged to transition to regular shoes as soon as they feel comfortable, which is usually 3 to 4 weeks after the injury. The more symptomatic patients with lower pain tolerances typically do better with the walker boot. 3 I treat the vast majority of tuberosity fractures in a hard-soled shoe or short Controlled Ankle Movement boot with full weight bearing permitted. Although originally thought to be caused by overpull of the peroneus brevis tendon when the foot supinates or adducts abruptly, literature has supported the notion that the lateral band of the plantar fascia is the primary cause. The most common fracture of the fifth metatarsal base is an avulsion of the tuberosity. Zones and fracture patterns of the fifth metatarsal base. Sir Robert Jones’ original description involving 4 cases, including his own, were acute fractures in the Zone II region. Fractures in the proximal portion of the diaphysis are considered Zone III. Zone II fractures are more distal and extra-articular (relative to the tarsometatarsal joint) and traverse the 4-5 intermetatarsal articulation. Zone I fractures occur through the tuberosity and are considered avulsion injuries. Quill 1 reported a classification of fifth metatarsal base fractures based on 3 zones (Figure 36-1). Diagnostic clarity is critical as it dictates treatment recommendations and prognosis. ![]() Unfortunately, the terminology and descriptions of these injuries remain confusing in the orthopedic literature. There are 3 distinct fracture patterns that affect the base of the fifth metatarsal. If you continue to have this issue please contact to Healio
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