Ortho Dx: The kind of fracture you can't miss - Clinical Advisor

Ortho Dx: The kind of fracture you can’t miss

Slideshow

  • Lateral radiograph of an 18-year-old patient’s left foot shows a proximal fifth metatarsal fracture at the metaphyseal-diaphyseal junction.

    Slide

    Lateral radiograph of an 18-year-old patient’s left foot shows a proximal fifth metatarsal fracture at the metaphyseal-diaphyseal junction.

  • Anteroposterior radiograph of the patient’s foot.

    Slide

    Anteroposterior radiograph of the patient’s foot.

An 18-year-old male presents with left foot pain after twisting his ankle during a basketball game 2 days previously. He was unable to continue playing after the injury and has had trouble putting weight on the foot ever since. On examination, he has tenderness to palpation over the proximal fifth metatarsal. Anteroposterior, lateral, and oblique radiographs of the foot are taken. 

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

The patient presents with a proximal fifth metatarsal fracture at the metaphyseal-diaphyseal junction, otherwise known as a Jones fracture. A Jones fracture is a "can't miss fracture" that must be recognized on initial radiographs. The metaphyseal-diaphyseal junction has poor blood...

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The patient presents with a proximal fifth metatarsal fracture at the metaphyseal-diaphyseal junction, otherwise known as a Jones fracture. A Jones fracture is a “can’t miss fracture” that must be recognized on initial radiographs. The metaphyseal-diaphyseal junction has poor blood supply and fractures in this region are prone to nonunion. To account for the slow healing in this area, a longer period of immobilization is required after fracture. Fractures proximal and distal have improved healing potential and fewer weight-bearing restrictions are required to treat them. The abundant metaphyseal arteries at each end of the fifth metatarsal allow for improved healing proximally and distally.1,2

 

Treatment of Jones fracture is individualized to the patient. Sedentary people or those who can tolerate a long period of non-weight bearing are treated in a boot or cast for 6 to 8 weeks. Weight bearing may be advanced after 6 to 8 weeks if there are radiographic signs of healing or if the patient has no pain. Active people, especially runners, may continue to have pain for several months after a Jones fracture, as the repetitive stress impairs healing. Intramedullary screw fixation is recommended for active patients looking to return to weight-bearing activities earlier. Intramedullary screw fixation improves healing time and thus allows an earlier return to weight-bearing activities. The nonunion rate for Jones fractures after 6 to 8 weeks of non-weight bearing and casting is estimated to be 7% to 28%; time to union may be as long as 21 weeks. In comparison, the average time to union for those treated surgically is estimated to be 7 to 8 weeks.1

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Rosenberg GA, Sferra JJ. Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal. J Am Acad Orthop Surg. 2000;8:332-338.
  2. Dameron TB. Fractures of the proximal fifth metatarsal: selecting the best treatment option. J Am Acad Orthop Surg. 1995;3:110-114.
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