Authors : W.S. Khan , R. Jain , M. Agarwal and C. Warren-Smith
Abstract: Fractures of the base of the fifth metatarsal are common injuries of the foot and it is important that a distinction is made between Jones` fractures and the more benign tuberosity fractures. Jones` fractures could be either acute fractures or stress fractures. It has previously been reported that stress fractures occur at an anatomic site more distal to that of acute fractures and this has been implicated as a reason for delayed union in these stress fractures. We conducted a retrospective study of 322 patients with fractures of the base of fifth metatarsal. This is one of the largest reported series of such fractures. Of these 288 were tuberosity fractures and 34 were Jones` fractures. The presence of stress- related features and the distance of the fracture site from the proximal tip of the metatarsal was measured for Jones` fractures. All avulsion fractures were managed symptomatically and non-operatively. They healed well in a mean follow-up period of 2 months and none required surgical intervention. The management of Jones` fractures varied depending on the surgeon whose care the patients were under. These fractures took longer to heal and only 14 out of 34 fractures healed using non-operative means in a mean follow-up period of 16 months. Four fractures required medullary curettage and bone grafting. Ten fractures had asymptomatic non-union and 6 were still under review. Statistical analyses showed that stress fractures do not occur at anatomically distinct locations to acute fractures. There was also no statistically significant correlation between distance from the proximal tip of the fifth metatarsal to the fracture site and union, or time to union. Tuberosity fractures, provided they are not significantly displaced, should be managed symptomatically. The treatment of choice for acute Jones` fractures is immobilization of the limb in a below-knee non-weight bearing plaster for 6 to 8 weeks. Jones` fractures with stress-related features may benefit from early surgery.
W.S. Khan , R. Jain , M. Agarwal and C. Warren-Smith , 2006. Fractures of the Base of the Fifth Metatarsal-A Review of 322 Patients. Surgery Journal, 1: 65-68.