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The current literature lacks studies that compare operative and nonoperative management for Jones and proximal diaphyseal fifth metatarsal fractures. Operative treatment usually is recommended for patients with a proximal diaphyseal fifth metatarsal fracture. In contrast, a proximal diaphyseal fifth metatarsal fracture may have a protracted healing time of as much as 21 months and nonunion can develop in as much as 25% of nonoperatively treated cases. Operative treatment is selected if the patient is a high-performance athlete or nonoperative treatment fails. According to numerous authors, a Jones fracture can be treated with 6 to 8 weeks of nonweightbearing immobilization resulting in fair to good outcomes. The treatments and prognosis of these fractures are distinguished by differences in anatomic location and natural history. The mechanism of this injury is believed to be a repetitive load applied under the metatarsal head over a relatively short time, resulting in an overuse phenomenon. A proximal diaphyseal fifth metatarsal stress fracture is defined as a stress fracture in the zone of the proximal fifth metatarsal immediately distal to the Jones fracture’s anatomic area.

The mechanism of injury is believed to be an abduction force applied to the forefoot with simultaneous ankle plantar flexion. A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation. More recent literature defines differences in diagnosis and prognosis between acute Jones and proximal diaphyseal stress fractures. The Jones fracture initially was described by Sir Robert Jones in 1902, and a review of his article showed both fracture types are included in his clinical cases and radiographs. The distinction between Jones and proximal diaphyseal fractures of the fifth metatarsal is often confusing for many physicians, even orthopaedists who are active in sports medicine and foot and ankle treatment. See the Guidelines for Authors for a complete description of levels of evidence. Level of Evidence: Level IV, therapeutic study. We suggest referring to fifth metatarsal base fractures (excluding avulsions) as Jones fractures. Based on our findings, we do not find a reason to distinguish between fractures of the fifth metatarsal in these two locations. Operatively treated patients with fracture site sclerosis or medullary canal obliteration on radiographs had lower satisfaction and higher complication rates than patients without these changes. Shorter return to sport time was observed in operatively treated patients. Regardless of treatment, the clinical outcomes were not different between the two fracture locations. All fractures healed between 4.8 and 9.8 months with a 78% to 82% patient satisfaction rate. Thirty-two Jones fractures and 29 proximal diaphyseal fractures were identified. Outcomes were analyzed using Student’s t tests, whereas nominal data were analyzed using chi square tests. Initial management is nonoperative however, intramedullary screw fixation is performed for competitive athletes, or others with displaced fractures, or delayed union or nonunion. Retrospectively, the two diagnoses were identified radiographically using an accepted classification scheme. We determined whether it is necessary to differentiate between these two diagnoses. Functional weight-bearing such as Robert Jones bandage or elastic bandaging and stiff-soled shoes has better outcomes than non-weight-bearing in a short leg cast 5.įor large or very displaced fragments with intra-articular extension then operative fixation may be indicated.Jones and proximal diaphyseal fractures of the fifth metatarsal are in close anatomic proximity and often are difficult to differentiate. In general, these fractures can be treated conservatively, and heal well 2. In some instances, the fracture may be occult. It usually does not reach the tarsometatarsal (metatarsocuboid) joint, but occasionally does. Small fracture usually of the tuberosity of the proximal 5 th metatarsal, orientated mostly transversely (cf.