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Surgical Management of Fifth Metatarsal (Jones) Fractures via Intramedullary Screw Fixation

March 01, 2019

Contributors: Laith M Jazrawi, MD, FAAOS; Dylan Lowe, MD; Benjamin Kester, MD; Benjamin Kester, MD

Fractures of the base of the fifth metatarsal are one of the most common fractures that occur in the foot. This fracture pattern was initially described by Sir Robert Jones in 1902 after he sustained the injury during a dance accident. Although proximal tuberosity fractures often are managed nonsurgically, injuries in the metaphyseal-diaphyseal region (commonly referred to as Jones fractures) are problematic. High rates of nonunion or delayed union are observed in this region secondary to a vascular watershed. Although the management of Jones fractures is controversial, most studies agree that a period of non-weight-bearing is necessary to allow for healing; however, delayed union is common. Athletes and highly active individuals may elect to undergo surgical fixation to accelerate recovery and return to sport. This video demonstrates intramedullary screw fixation of metaphyseal-diaphyseal injuries, or Jones fractures, of the base of the fifth metatarsal. The video provides an overview of the anatomy, pathogenesis, and treatment options for the management of Jones fractures. The video discusses the case presentation of a 23-year-old male collegiate athlete with a traumatic Jones fracture. The patient underwent cannulated intramedullary screw fixation and successfully returned to sports activity. The results of surgical and nonsurgical management of Jones fractures and recommended postoperative management strategies are reviewed. Acute fractures in the metaphyseal-diaphyseal region of the proximal fifth metatarsal may be difficult to manage. Nonunion rates are high in patients who undergo nonsurgical treatment, and surgical intervention is controversial; however, primary surgical fixation with the use of a cannulated intramedullary screw is technically feasible and affords reliable outcomes. If surgical intervention is warranted, intramedullary screw fixation of proximal fifth metatarsal fractures is the preferred treatment option. Decreased time to union, high union rates, and accelerated return to sport can be expected in athletes who undergo this procedure.