Show Notes
Background:
Why do we care about Jones fractures?
Propensity for poor healing due to watershed area of blood supply
Fifth metatarsal fractures account for 68% of metatarsal fractures in adults
Proximal 5th metatarsal fractures are divided into 3 zones (93% zone 1, 4% zone 2, 3% zone 3)
Zone 1 (pseudo-Jones):
Tuberosity avulsion fracture
Typically avulsion type injuries due to acute episode of forefoot supination with plantar flexion
Typical fracture pattern is transverse to slightly oblique
Zone 2 (Jones fracture):
Fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal
Typically acute episode of large adduction force applied to forefoot with the ankle plantar flexed
Zone 3:
Proximal diaphyseal stress fracture
Typically results from a fatigue or stress mechanism
Clinical Presentation:
History of acute or repetitive trauma to forefoot
Fracture type / pattern closely related to injury location
Foot often swollen, ecchymotic, very tender to fifth metatarsal +/- crepitus, inability to hear weight
Diagnosis:
Clinical exam:
Evaluate skin integrity
Check neurovascular status
Evaluate toes/ feet/ ankles/ tib fib/ knees/ hips, involved tendon function, associated adjacent structures (Achilles, ankle ROM/ function, etc)