Jones fracture

This teenage footballer presented after a plantarflexion and inversion injury to his left foot.  He described a cracking sensation followed by immediate pain and inability to weight-bear or continue to play football.  He denied any problems prior to this injury.  On examination he had localised tenderness over the base of his fifth metatarsal. He was able to weight-bear only with great difficulty.

This x-ray image shows a fracture involving the fifth metatarsal shaft.  The x-rays at the time of injury show some thickening of the cortex which may indicate a degree of chronicity.  Images taken two months later show that the fracture appears to be healing and is less well defined. 

While this fracture is essentially undisplaced, it is in a region which typically goes on to non or delayed union. This type of fracture is commonly referred to as a ‘Jones’ fracture. It behaves differently to the avulsion fractures that can also occur at this site – these typically involve the joint surface and heal predictably.  In contrast a Jones fractures is extra-articular and occurs at the junction of the metaphysis and diathesis. In practice this is usually between 1.5cm and 3cm distal to the tuberosity.  Unlike simple avulsion fractures of the tuberosity these injuries often go on to non-union and can take a prolonged period to heal.  In an elite player this injury is often managed with surgery as this generally gives a more predictable outcome.  However this case illustrates that these fractures can also be successfully managed without surgery.  This player was treated with a six-week period of non-weight bearing immobilisation in a boot.  He was then able to progressively return to football over a one-month period.  In total he had three months away from football.  At six months follow-up he is asymptomatic and has returned to all normal sporting pursuits.

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