Jones Fracture

JONES FRACTURE
By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

Jones fractures are fractures of the fifth metatarsal that occur in an area of the fifth metatarsal that has a poor blood supply. Jones fractures are more common in active people and are very common in football, basketball and soccer players. These fractures have often been described as excessive stress to the fifth metatarsal, especially with the foot pointed in a down position in which the ankle also rolls to the outside. This is also commonly seen in athletes that have a high arch foot or ones that have the front part of the foot turned in relative to the back part of the foot.

Pain in the fifth metatarsal in an athletic person should often be evaluated relatively quickly after it is felt. Stress to the fifth metatarsal may weaken the bone, predisposing it to more simple trauma that can break the bone in an area with poor circulation. Initial x-rays may be necessary but if the clinical exam is consistent with an injury, MRls may be necessary to further evaluate the injury. If MRls do show that there is bone marrow edema then this injury should be treated with a period of immobilization to allow the area to heal. Failure to address this when it is in a pre-fracture stage may predispose the athlete to further injury.

If the x-ray does show that the bone has fractured in the region with poor circulation, conservative and surgical treatment options are offered. Conservative care includes a nonweightbearing cast for eight weeks. A return to sports may be 3-4 months. There is a high risk of refracture to this area in athletes with a high arch foot. In those patients surgical treatment may be performed initially to allow the fracture to heal more rapidly and return the athlete back to their sporting activity. This would require nonweightbearing for six weeks in a boot. Athletes can usually return to activity following the use of screw fixation in approximately 10-12 weeks.

Jones fractures can often go on to delayed union. This means that the fracture is not healing in the expected time. In those cases bone stimulators may be used to help accelerate the healing process. In some cases this fracture may go on to a nonunion. Nonunions of the fifth metatarsal can become very painful and cause a disability in a running athlete. It will most often require surgery to remove the areas of the bone that are devoid of blood supply. A bone graft is then applied to the fracture and a small plate or screw is utilized to stabilize the fractured area. Nonweightbearing for 8-12 weeks would be mandatory. Long-term prognosis is excellent. If there is a foot deformity that predisposes the patient to increased stress to the fifth metatarsal, surgery would be necessary in these other areas to unload the fifth metatarsal more permanently.

Jones Fracture Status Post Percutaneous Screw Fixation

Jones fractures are specific in that they occur at the base of the 5th metatarsal occuring away from the articular surface, and are a common injury in certain sports such as basketball. These fractures are precarious in their character in that the area of the bone in question where the fracture takes place which has less blood supply than the remainder of the bone, therefore compromising healing potential of this area. 

Preop and Postop Metaphyseal Diaphyseal Stress Fracture Fifth Metatarsal Percutaneous Screw Fixation

Preop and Postop Jones Fracture

This patient neglected her fracture for 2 months before seeing a doctor. She walked in a boot for a couple months but did not heal

Percutaneous Screw fixation and 16 weeks later she is healed and pain free

Jones Fracture Pre and Postop

Jones Fracture Preop and Postop

Preop and Postop Jones Fracture Fixation

Preop and 12 Wks Postop Jones Fracture

Preop Photos of Jones Fracture prior to fixation

 

 

These X-rays of the foot after surgical repair of the Jones Fracture which is important to stabilize this fracture not only for adequate healing but also because of soft tissue structures such as ligament and tendon that attach to the base of the 5th metatarsal.

 

Preop and Postop Jones Fracture

This patient neglected her fracture for 2 months before seeing a doctor. She walked in a boot for a couple months but did not heal

Percutaneous Screw fixation and 16 weeks later she is healed and pain free

Preop and Postop Percutaneous Fixation Jones Fracture

 

 

Preop and Postop X-rays of a Jones Fracture.

The first two images are prior to percutaneous screw fixation

 

The following two images are after percutaneous screw fixation

 

Diaphyseal stress fracture before and after percutaneous screw fixation

Preop and Postop Jones Fracture Repair

Preop and Postop Jones Fracture Fixation

Series of Jones repair with Percutaneous Screw

Pics of the Fracture prior to repair

Intraop pics after percutaneous screw fixation