Ortho Hors D'oeuvres (Answer):

To review, this is a 17 year-old girl presenting after a forced inversion injury to her right foot while playing soccer.

Questions and Answers:

1) What is the key finding on x-ray?

On this AP x-ray of the right foot you can see a fracture to the base of the 5th metatarsal.

2) What is the name of this injury? What are the major complications if it goes untreated?

This fracture is called a Jones fracture. This fracture occurs in a vascular watershed area, which makes this fracture have a higher chance of nonunion.

It’s important to differentiate between a Jones fracture and a Pseudo-jones (or dancer’s) fracture. Pseudo-jones fractures typically occur because of forced inversion injuries and are a result of avulsion of the tuberosity of the 5th metatarsal. The fracture lines will not go into the 4th-5th metatarsal articulation.

Jones fractures occur slightly more distally and do involve the 4th-5th metatarsal articulation site.

3) What is the management for this injury and other injuries of the same bone?

Jones fractures: Fractures require a short-leg cast or a boot and are nonweightbearing until otherwise instructed by a specialist. They should follow-up within one week with our orthopedic colleagues.

Pseudo-jones fractures: Fractures require a hard-soled shoe; allow the patient to bear weight as tolerated. Follow-up should be within 1-2 weeks with a primary care doctor or an orthopedic specialist. They can expect to heal within 4-6 weeks after conservative treatment

References:

Polzer JP, Polzer S, Mutschler W, Prall WC. Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury. 2012 Oct;43(10):1626-32.

Lee J. “Know the difference between a jones fracture and a pseudo-jones fracture.” Avoiding Common errors in the emergency department. Ed Mattu, A. Lippincott and Williams, 2012. 790-792.

Konkel KF, Menger AG, Retzlaff SA. Nonoperative treatment of fifth metatarsal fractures in an orthopaedic suburban private multispecialty practice. Foot Ankle Int. 2005;26(9)704-707.

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