Proximal Fifth Metatarsal Jones Fractures

CHAPTER 41
Proximal Fifth Metatarsal Jones Fractures

Internal Fixation

Steven Kodros

• Jones fractures are transverse fractures located at the proximal metaphyseal-diaphyseal junction of the fifth metatarsal.

• Jones fractures have a much higher incidence of developing a symptomatic nonunion or fibrous union than simple avulsion fractures of the fifth metatarsal tuberosity (located more proximally) (Fig. 41–1).

• Commonly, nonoperative treatment includes a short leg cast and non-weight-bearing for 6 to 8 weeks. After this period, patients can be converted to either a short leg brace or walking cast which is maintained until fracture union has occurred (usually another 6 to 8 weeks).

Indications

1. Proximal fifth metatarsal (Jones) fractures that fail to show rogression toward bony union after treatment in a non-weight-bearing short-leg cast for 6 to 8 weeks

2. Acute proximal fifth metatarsal (Jones) fractures in young athletic individuals who wish to shorten the time to return to sport and minimize the prolonged course of immobilization and rehabilitation that is associated with nonoperative treatment

3. Proximal fifth metatarsal (Jones) fractures in patients who desire surgical management, as opposed to non-operative treatment

4. Stress fractures, delayed unions, or nonunions of the proximal fifth metatarsal

Contraindications

1. Medullary canal diameter that is too small to accommodate an adequate-sized screw

2. Patients with conditions that may increase the risk of wound healing problems (e.g., peripheral vascular disease, diabetes mellitus, heavy tobacco use) (relative)

Preoperative Preparation

1. Determine the appropriate screw size by measuring the width of the fifth metatarsal’s medullary canal on the preoperative radiographs. Commonly, a screw that is between 4.5 and 6.5 mm in size will usually provide appropriate canal fill and purchase and have adequate strength for internal fixation.

Special Instruments, Position, and Anesthesia

1. A cannulated screw system will facilitate intramedullary screw placement when using a “relatively” percutaneous technique.

2. Intraoperative fluoroscopy and a radiolucent operating table are necessary for accurate screw placement.

3. The patient is positioned supine on the operating table with a large padded roll placed beneath the ipsilateral buttock. This helps to internally rotate the affected extremity.

4. The procedure can be done under an ankle block with the use of monitored anesthesia care and intravenous sedation. Alternatively, general or other methods of regional anesthesia can be employed.

5. An ankle tourniquet (just above the malleoli) is utilized and set at 250 mm Hg.

Tips and Pearls

1. Prior to the procedure, ensure that adequate fluoroscopic images of the fifth metatarsal can be obtained in multiple projections, including anteroposterior, lateral, and oblique views.

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