Jones fracture

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Jones fracture
Other namesFracture of the metaphysis of the fifth metatarsal [1]
Cropped version of Jonesfracture.jpg
Jones fracture as seen on Xray
Specialty Emergency medicine, orthopedics, podiatry
Symptoms Pain near the midportion of the foot on the outside, bruising [2] [3]
Usual onsetSudden [4]
Duration6-12 weeks to heal [5]
CausesBending the foot inwards when the toes are pointed [6]
Diagnostic method Based on symptoms, X-rays [3]
Differential diagnosis Pseudo-Jones fracture, normal growth plate [3] [7]
TreatmentNon-weight bearing, cast, surgery [5]

A Jones fracture is a broken bone in a specific part of the fifth metatarsal of the foot between the base and middle part [8] that is known for its high rate of delayed healing or nonunion. [4] It results in pain near the midportion of the foot on the outside. [2] There may also be bruising and difficulty walking. [3] Onset is generally sudden. [4]

Contents

The fracture typically occurs when the toes are pointed and the foot bends inwards. [6] [2] This movement may occur when changing direction while the heel is off the ground such in dancing, tennis, or basketball. [9] [10] Diagnosis is generally suspected based on symptoms and confirmed with X-rays. [3]

Initial treatment is typically in a cast, without any walking on it, for at least six weeks. [5] If, after this period of time, healing has not occurred, a further six weeks of casting may be recommended. [5] Due to poor blood supply in this area, the break sometimes does not heal and surgery is required. [3] In athletes, or if the pieces of bone are separated, surgery may be considered sooner. [5] [8] The fracture was first described in 1902 by orthopedic surgeon Robert Jones, who sustained the injury while dancing. [11] [4]

Diagnosis

A person with a Jones fracture may not realize that a fracture has occurred. Diagnosis includes the palpation of an intact fibularis brevis tendon, and demonstration of local tenderness distal to the tuberosity of the fifth metatarsal, and localized over the shaft of the proximal metatarsal.

Diagnostic X-rays include anteroposterior, oblique, and lateral views and should be made with the foot in full flexion.[ citation needed ]

Differential diagnosis

Proximal fractures of the fifth metatarsal bone: - Proximal diaphysis, typically stress fracture. - Metaphysis: Jones fracture -Tuberosity: Pseudo-Jones fracture (avulsion fracture). Normal anatomy: - Apophysis: Normal at 10 - 16 years. - Os vesalianum, an accessory bone. Proximal fractures of 5th metatarsal.jpg
Proximal fractures of the fifth metatarsal bone:
- Proximal diaphysis , typically stress fracture.
- Metaphysis : Jones fracture
- Tuberosity : Pseudo-Jones fracture (avulsion fracture).
Normal anatomy:
- Apophysis: Normal at 10 - 16 years.
- Os vesalianum, an accessory bone.
Pseudo-Jones fracture Cropped version of JonesFracture1.jpg
Pseudo-Jones fracture

Other proximal fifth metatarsal fractures exist, although they are not as problematic as a Jones fracture. If the fracture enters the intermetatarsal joint, it is a Jones fracture. If, however, it enters the tarsometatarsal joint, then it is likely an avulsion fracture caused by pull from the fibularis brevis tendon. An avulsion fracture at the base of the fifth metatarsal is sometimes called a "dancer's fracture" or a "pseudo Jones fracture", and usually responds readily to non-operative treatment. [18] The X-ray appearance of the developmental "apophysis" in this area may have some resemblance of a fracture, but is not a fracture; it is the secondary ossification center of the metatarsal bone. It is a normal finding that occurs at this site in adolescents. [19] If an injury to that area has occurred, the physician is often able to interpret certain radiographic clues to make the differentiation. An avulsion fracture at this location is typically extra-articular and oriented transversally as compared to the longitudinal orientation of an unfused apophysis. [19]

Treatment

Casting

Initial treatment is typically in a cast, without any weight being placed on it, for at least six weeks. [5] If after this period of time healing has not occurred a further six weeks of casting may be recommended. [5] Up to half, however, may not heal after casting. [2]

Surgery

In athletes or if the pieces of bone are separated by more than 2 mm surgery may be considered. [5] [8] In a study of all players who entered the NFL Scouting Combine from 2009 to 2015, the incidence of Jones fracture was 3.2% and all had received surgery to repair the fracture with a metal screw. [20] For persons who are not athletes, surgery might not be recommended unless healing does not occur after a trial of cast treatment. [5]

Prognosis

For several reasons, a Jones fracture may not unite. The diaphyseal bone (zone II), where the fracture occurs, is an area of potentially poor blood supply, existing in a watershed area between two blood supplies. This may compromise healing. In addition, there are various tendons, including the fibularis brevis and fibularis tertius, and two small muscles attached to the bone. These may pull the fracture apart and prevent healing.[ citation needed ]

Zones I and III have been associated with relatively guaranteed union and this union has taken place with only limited restriction of activity combined with early immobilization. On the other hand, zone II has been associated with either delayed or non-union and, consequently, it has been generally agreed that fractures in this area should be considered for some form of internal immobilization, such as internal screw fixation.[ citation needed ]

These zones can be identified anatomically and on x-ray adding to the clinical usefulness of this classification. [21] Surgical intervention is not, by itself, a guarantee of cure and has its own complication rate. Other reviews of the literature have concluded that conservative, non-operative, treatment is an acceptable option for the non-athlete. [22]

Related Research Articles

<span class="mw-page-title-main">Foot</span> Anatomical structure found in vertebrates

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws and/or nails.

<span class="mw-page-title-main">Toe</span> Digit of a foot

Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of their toes.

<span class="mw-page-title-main">Bunion</span> Deformity characterized by lateral deviation of the big toe

A bunion, also known as hallux valgus, is a deformity of the MTP joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.

<span class="mw-page-title-main">Ankle</span> Region where the foot and the leg meet

The ankle, the talocrural region or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantarflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" can refer broadly to the region or specifically to the talocrural joint.

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

<span class="mw-page-title-main">Plantar fascia</span> Aponeurosis of the sole of the foot

The plantar fascia or plantar aponeurosis is the thick connective tissue aponeurosis which supports the arch on the bottom of the foot. Recent studies suggest that the plantar fascia is actually an aponeurosis rather than true fascia. It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones.

<span class="mw-page-title-main">Stress fracture</span> Bone fracture due to repeated stressing

A stress fracture is a fatigue-induced bone fracture caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated injury from repeated submaximal loading, such as running or jumping. Because of this mechanism, stress fractures are common overuse injuries in athletes.

<span class="mw-page-title-main">Tarsus (skeleton)</span> Bones of the foot

In the human body, the tarsus is a cluster of seven articulating bones in each foot situated between the lower end of the tibia and the fibula of the lower leg and the metatarsus. It is made up of the midfoot and hindfoot.

<span class="mw-page-title-main">Lisfranc injury</span> Type of fracture/dislocation injury of the foot

A Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.

<span class="mw-page-title-main">Avulsion fracture</span> Tearing away of a bone by physical trauma

An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament by the application of forces external to the body or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. Generally muscular avulsion is prevented by the neurological limitations placed on muscle contractions. Highly trained athletes can overcome this neurological inhibition of strength and produce a much greater force output capable of breaking or avulsing a bone.

<span class="mw-page-title-main">Fibularis brevis</span> Shorter and smaller of the fibularis (peroneus) muscles

In human anatomy, the fibularis brevis is a muscle that lies underneath the fibularis longus within the lateral compartment of the leg. It acts to tilt the sole of the foot away from the midline of the body (eversion) and to extend the foot downward away from the body at the ankle.

<span class="mw-page-title-main">Morton's neuroma</span> Benign neuroma of an intermetatarsal plantar nerve

Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toe boxes and high heels. The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher.

<span class="mw-page-title-main">Mallet finger</span> Type of fracture

A mallet finger, also known as hammer finger or PLF finger or Hannan finger, is an extensor tendon injury at the farthest away finger joint. This results in the inability to extend the finger tip without pushing it. There is generally pain and bruising at the back side of the farthest away finger joint.

<span class="mw-page-title-main">Hallux rigidus</span> Arthritis and stiffness affecting the base joint of the big toe

Hallux rigidus or stiff big toe is degenerative arthritis and stiffness due to bone spurs that affects the metatarsophalangeal joints (MTP) at the base of the hallux.

<span class="mw-page-title-main">Fifth metatarsal bone</span> Long bone in the foot

The fifth metatarsal bone is a long bone in the foot, and is palpable along the distal outer edges of the feet. It is the second smallest of the five metatarsal bones. The fifth metatarsal is analogous to the fifth metacarpal bone in the hand.

<span class="mw-page-title-main">Calcaneal fracture</span> Medical condition

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

<span class="mw-page-title-main">Scaphoid fracture</span> Fracture of the scaphoid bone in the wrist

A scaphoid fracture is a break of the scaphoid bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.

<span class="mw-page-title-main">March fracture</span> Fracture of the metatarsal bones of the foot due to recurrent stress

March fracture is the fracture of the distal third of one of the metatarsal bones occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and other people whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.

In the skeleton of humans and other animals, a tubercle, tuberosity or apophysis is a protrusion or eminence that serves as an attachment for skeletal muscles. The muscles attach by tendons, where the enthesis is the connective tissue between the tendon and bone. A tuberosity is generally a larger tubercle.

<span class="mw-page-title-main">Broken toe</span> Medical condition

A broken toe is a type of bone fracture. Symptoms include pain when the toe is touched near the break point, or compressed along its length. There may be bruising, swelling, stiffness, or displacement of the broken bone ends from their normal position.

References

  1. ↑ "5th Metatarsal". Emergency Care Institute, New South Wales. 2017-09-19. Archived from the original on 2019-07-29. Retrieved 2019-07-29.
  2. 1 2 3 4 Eltorai AE, Eberson CP, Daniels AH (2017). Orthopedic Surgery Clerkship: A Quick Reference Guide for Senior Medical Students. Springer. pp. 395–397. ISBN   9783319525679. Archived from the original on 2017-10-15.
  3. 1 2 3 4 5 6 "Toe and Forefoot Fractures". OrthoInfo - AAOS. June 2016. Archived from the original on 16 October 2017. Retrieved 15 October 2017.
  4. 1 2 3 4 Valderrabano V, Easley M (2017). Foot and Ankle Sports Orthopaedics. Springer. p. 430. ISBN   9783319157351. Archived from the original on 2017-10-15.
  5. 1 2 3 4 5 6 7 8 9 Bica D, Sprouse RA, Armen J (February 2016). "Diagnosis and Management of Common Foot Fractures". American Family Physician. 93 (3): 183–91. PMID   26926612.
  6. 1 2 Dähnert W (2011). Radiology Review Manual. Lippincott Williams & Wilkins. p. 96. ISBN   9781609139438. Archived from the original on 2017-10-15.
  7. ↑ Conaghan PG, O'Connor P, Isenberg DA (2010). Musculoskeletal Imaging. OUP Oxford. p. 231. ISBN   9780191575273. Archived from the original on 2017-10-15.
  8. 1 2 3 Joel A. DeLisa; Bruce M. Gans; Nicholas E. Walsh (2005). Physical Medicine and Rehabilitation: Principles and Practice. Lippincott Williams & Wilkins. pp. 881–. ISBN   978-0-7817-4130-9. Archived from the original on 2017-01-07.
  9. ↑ Mattu A, Chanmugam AS, Swadron SP, Tibbles C, Woolridge D, Marcucci L (2012). Avoiding Common Errors in the Emergency Department. Lippincott Williams & Wilkins. p. 790. ISBN   9781451152852. Archived from the original on 2017-10-16.
  10. ↑ Lee E (2017). Pediatric Radiology: Practical Imaging Evaluation of Infants and Children. Lippincott Williams & Wilkins. p. Chapter 24. ISBN   9781496380272. Archived from the original on 2017-10-15.
  11. ↑ Jones R (June 1902). "I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence". Annals of Surgery. 35 (6): 697–700.2. PMC   1425723 . PMID   17861128.
  12. ↑ Bica D, Sprouse RA, Armen J (February 2016). "Diagnosis and Management of Common Foot Fractures". American Family Physician. 93 (3): 183–91. PMID   26926612.
  13. ↑ "5th Metatarsal". Emergency Care Institute, New South Wales. 2017-09-19.
  14. ↑ "Toe and Forefoot Fractures". OrthoInfo - AAOS. June 2016. Archived from the original on 16 October 2017. Retrieved 15 October 2017.
  15. 1 2 Silbergleit R. "Foot Fracture". Medscape.com. Retrieved 19 October 2011.
  16. ↑ Deniz G, Kose O, Guneri B, Duygun F (May 2014). "Traction apophysitis of the fifth metatarsal base in a child: Iselin's disease". BMJ Case Reports. 2014 (may14 4): bcr2014204687. doi:10.1136/bcr-2014-204687. PMC   4025211 . PMID   24832713.
  17. ↑ Nwawka OK, Hayashi D, Diaz LE, Goud AR, Arndt WF, Roemer FW, et al. (October 2013). "Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology". Insights into Imaging. 4 (5): 581–93. doi:10.1007/s13244-013-0277-1. PMC   3781258 . PMID   24006205.
  18. ↑ "Toe and Forefoot Fractures/Fifth Metatarsal Fractures". orthoinfo.aaos.org. American Academy of Orthopedic Surgeons. Retrieved November 3, 2021.
  19. 1 2 Saber, Mohamed; Sharma, Rohit (March 26, 2021). "Apophysis of the proximal 5th metatarsal". radiopaedia.org. Radiopedia.org. Retrieved November 3, 2021.
  20. ↑ Spang, Robert C. (August 2018). "Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance". Orthopaedic Journal of Sports Medicine. 6 (8). doi:10.1177/2325967118790740. ISSN   2325-9671. PMC   6113739 . PMID   30182027.
  21. ↑ Polzer H, Polzer S, Mutschler W, Prall WC (October 2012). "Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence". Injury. 43 (10): 1626–32. doi:10.1016/j.injury.2012.03.010. PMID   22465516.
  22. ↑ Dean BJ, Kothari A, Uppal H, Kankate R (August 2012). "The jones fracture classification, management, outcome, and complications: a systematic review". Foot & Ankle Specialist. 5 (4): 256–9. doi:10.1177/1938640012444730. PMID   22547534. S2CID   37169110.
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