This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of proximal fifth metatarsal fractures

Barnett, Tiffany

Chan, Jonathan

Diaz, Manual

English

University of Missouri: MOspace

 Sports Fracture of the Fifth Proximal Metatarsal     Page 1 of 3   5.14.08 Proximal Fifth Metatarsal Fracture  See also Metatarsal Fractures  Background 1. Most common site of midfoot fractures 2. Two types  o Jones fractures o Pseudo-Jones fractures: "Ballet Dancer's Fracture"  Pathophysiology 1. Proximal fifth metatarsal comprised of three zones  o Zone 1: most proximal area   Attachment of peroneus brevis  Lateral plantar aponeurosis   Articulation w/cuboid  Pseudo-Jones fracture seen in this zone   Proximal avulsion fracture  Associated w/lateral ankle sprain o Zone 2: metaphyseal diaphyseal junction   Jones fracture   Transverse fracture at base of 5th metatarsal  1.5-3cm distal to tuberosity   Associated w/  o Pivoting foot or cutting w/ankle plantar flexed (w/heel off ground) o Adduction force to forefoot  o Zone 3: proximal diaphysis   Prone to stress fractures  Diagnostics 1. X-ray: AP, lateral, oblique 2. Jones Fracture Torg Classification System:  o Type I   No intramedullary sclerosis   Well-delineated fracture line  Minimal cortical hypertrophy o Type II (delayed union)   Fracture line involves both cortices w/periosteal new bone  Widened fracture line  Intramedullary sclerosis o Type III (nonunion)   Wide fracture line w/periosteal new bone and radiolucency  Sclerotic bone  Obliterated medullary canal  Therapeutics 1. Pseudo-Jones fracture  o Conservative/ symptomatic tx  o Wt bearing as tolerated   Sports Fracture of the Fifth Proximal Metatarsal     Page 2 of 3   5.14.08  Most heal in 6-8 wks 2. Jones fracture  o Type I   Non-wt bearing  Immobilized for 6-8 wks o Type II & III:   Operative tx w/bone graft or intramedullary screw fixation   Shown to reduce time to clinical union by 50%   Fitted w/well-padded splint/ cast  Wt bearing 7-10 days post-op   Prognosis 1. Return to play  o Pseudo- Jones fracture   Gradual return to play (verify radiographic union) o Jones fracture   Start moderate aerobic work 2-3 wks post-op   12 wks for sport-specific activities (verify radiographic union) 2. Complications  o Sural nerve damage from intramedullary screw o Non-union o Refracture o Screw breakage  Patient Education 1. http://orthopedics.about.com/cs/lowerfx/g/fifthmetatarsal.htm  References 1. Dameron TB Jr. Fractures of the proximal fifth metatarsal: selecting the best treatment option. J Am Acad Orthop Surg 1995; 3:110-4. 2. Fetzer, GB, Wright RW. Metatarsal shaft fractures and fractures of the proximal fifth metatarsal. Clin Sports Med 2006; 25(1):139-50. 3. Holmes GB Jr. Treatment of delayed unions and nonunions of the proximal fifth metatarsal with pulsed electromagnetic fields. Foot Ankle Int 1994; 15:552-6. 4. Mologne TS, Lundeen JM, Clapper MF, O'Brien TJ. Early screw fixation Med 2005; 33:970-5. 5. Nunley JA. Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am 2001; 32:171-80. 6. Quill GE Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am 1995; 26:353-61. 7. Rooks YL, Corwell B. Common urgent musculoskeletal injuries in primary care. Prim Care Clinic Office Pract 2006; 33:751-777. 8. Wall J, Feller JF. Imaging of stress fractures in runners. Clin Sports 2006; 25(4):781-802. 9. Zenios M, Kim WY, Sampath J, Muddu BN. Functional treatment of acute metatarsal fractures: a prospective randomised comparison of management in a cast versus elasticated support bandage. Injury 2005; 36:832-5.   Sports Fracture of the Fifth Proximal Metatarsal     Page 3 of 3   5.14.08  Evidence-based Inquiry 1. What is the most effective management of acute fractures of the base of the fifth metatarsal?    Authors:  Jonathan Chan, DO, Manual Diaz, DO, & Tiffany Barnett, MD  Editor:  Carol Scott, MD, University of Nevada Reno FPRP                                                      

Proximal fifth metatarsal fracture

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Proximal fifth metatarsal fracture

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