Published by Dr.Sk Golam Mahbub

1. WELCOME
Short Notes Presentation

2. JONES FRACTURE
Dr. Sheikh Golam Mahbub
D(Ortho)Student
Orthopaedics Surgery
BSMMU

3. What is Jones Fracture ?
 The Jones fracture is defined as a fracture
1.5 cm distal to the tuberosity of the 5th meta
tarsal base in which the main fracture line
extend in to the 4th-5th metatarsal articulations.

4. Why it is called jones fracture ?
 First described in 1902 by orthopedic surgeon
Sir Robert Jones.
 He sustained the injury himself(while dancing) as a
fracture of the 5th metatarsal about three-fourths of
an inch from its base.

5. Anatomy
 The peroneus brevis tendon and
lateral band of the plantar fascia
insert onto the base of the fifth
metatarsal.
 There is a relative watershed in the
blood supply to the 5th metaTarsal at
the junction between the diaphysis
and metaphysis.

6. Continue…
 Proximally, affecting the tuberosity, in the region
of articulation with the fourth metatarsal, or at the
metaphyseal/diaphyseal junction.
 Higher rate of non-union, probably as a
consequence of the relatively poor blood supply
in that region.

7. Mechanism Of Injury
 The fracture is believed to occur as a result of significant adduction force to the
forefoot with the ankle in plantar flexion

8. Clinical Presentation
 Pain over this middle/outside area of
foot
 Swelling
 Difficulty Walking

9. Radiological Findings
 Diagnostic x-rays include anteroposterior, oblique, and lateral views and should be
made with the foot in full flexion.
 X-Ray shows a transverse fracture near the metatarsal base , usually small
fragment & Minimally displaced.
 Should not be confused with normal apophysis of the proximal 5th metatarsal.

10. Classification of fracture
(According to site)

11. Classification of Fracture of 5th Metatarsal
 Type Description
 I Acute fractures at the metaphyseal-diaphyseal junction.
 IA Nondisplaced
 IB Displaced or comminuted or both.
 II Fractures at the metaphseal-diaphyseal junction with clinical or
radiographic evidence of previous injury (i.e., pain, sclerosis).
 III Fractures of the styloid process of the fifth metatarsal.
 IIIA Without involvement of the fifth metatarsocuboid joint.
 IIIB With involvement of the fifth metatarsocuboid joint.

12. Differntial Diagnosis
 Avulsion Fracture
 Os Peroneum
 Diaphyseal Stress Fractures

13. Treatment
 Non Surgical
 Until you are able to see a foot & ankle surgeon. the “R.I.C.E”
method of care should be performed
 REST : Stay off the injured foot
 ICE: Apply an icepack to the injured area
 COMPRESSION: An elastic wrap should be used to control swelling
 ELEVATION: The foot should be raised above the level of
Heart to reduce swelling
 If a jones fractures is not significantly displaced, it can be treated with a cast,splint or
walking boot for 4 to 8 weeks.

14. When is Surgery Needed
 Zone 1 treated without surgery cast, boot or hard-soled shoe
heal within six to eight weeks.
 Zone 2 higher chance of nonunion risk of refracture even after healing.
Surgical treatment is common.
 Zone 3 typically stress fractures in athletes risk of refracture may be
reasons for surgical repair in these fractures.

15. Type l Fractures
 Type IA fracture (acute)
 Non–weight bearing,
 Short leg cast is worn for 6 to 8 weeks followed by a weight bearing
cast until union has been achieved
 Type IB fractures with displacement and comminuted
 In competitive athletes, consideration should be given to early open reduction
and internal fixation to decrease disability time.
 use of electrical and pulsed ultrasound and bone stimulation for may improve
healing of the fracture.
 Surgery should be considered for type I fractures that are not healing clinically at 8
to 12 weeks

16. Type ll Fractures
 Type II fractures (partial or complete canal obliteration and sclerosis)
 Non–weight bearing casting may yield satisfactory results.
 Immobilization and non–weight bearing is approximately 8 weeks.
 Refracture is common in this category
 Surgery should be considered for type II fractures in competitive athletes and
others whose occupational demands do not allow prolonged non–weight bearing
immobilization

17. Type lll Fractures
 Type III fractures
 Short leg cast for 3 weeks followed by a well-molded arch support.
 Nonunions of type III fractures may occur, they rarely are painful and can be
treated with excision of the fragment

18. Surgical Treatment
 Fixation with a medullary 4.5-mm malleolar screw
 Corticocancellous in lay bone grafting with clearing of the medullary canal of all sclerotic
bone
 5.5-mm and larger cannulated screws, and non cannulated screws with low-profile heads.
 Fractures of the shaft of the metatarsal are typically fixed with a plate and screws

19. Surgical Approach
 Incision through skin only
• 1 fingerbreadth proximal to base of 5th MT
• Parallel to peroneals
 Supine position
 Flex knee and place foot on base

20. Post operative care
 A well-padded, short-leg, non-walking cast, extending to the toes, is applied.
 Non weight bearing for 2 weeks.
 Weight bearing in a cast may be started 2 weeks postoperatively.
 Ankle ROM against gravity abduction/adduction, planter and dorsiflexion.
 Return to competitive sports is usually takes 10 to 12 weeks.

21. Complications
 Refracture
 Screw Failure
 Non union
 Infection
 Sural nerve injury
 Hardware discomfort

22. Conclusions
 The Jones fracture presents a dilemma in treatment of the active patient.
 Jones fracture has a high rate of nonunion due to low vascular integrity.
 Though cast treatment has been shown to be effective, early screw fixation of the
Jones fracture will results in shorter times to union & return to activity.
 Operatively treated Jones fracture have a high success rate.
 Athlete should not be allowed to return to full activity until full radiographic union
is evidenced.
 Even with non–weight bearing immobilization for 6 to 8 weeks, type I fractures
have a reported nonunion rate of 7% to 28%.