At least three fracture types occur in the proximal fifth metatarsal: the Jones' fracture, the proximal diaphysial stress fracture, and the tuberosity avulsion fracture. Each has distinct characteristics. The diaphysial stress fracture is commonly confused with the Jones' fracture, thereby obscuring vital differences in prognosis and treatment. Anatomical and biomechanical characteristics, as well as vascular studies of the proximal portion of the fifth metatarsal, are discussed in an attempt to better understand their diverse healing potentials.
Guidelines for treatment are controversial, and must frequently be individualized. Although surgical intervention for certain proximal fifth metatarsal fracture types may speed recovery time, most fractures heal with immobilization. Treatment of displaced, intra-articular fractures, delayed unions, and nonunions usually requires operative methods.
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References
1.
. AckerJ.H.DrezD.: Nonoperative treatment of stress fractures of the proximal shaft of the fifth metatarsal (Jone's fractures). Foot Ankle, 7(3):152–154, 1986.
2.
. AndersonJ.E.: Grant's Atlas of Anatomy, 8th Ed. Baltimore, Williams & Wilkins, 1983, Sect. 4.
3.
. AndersonL.D.: Injuries of the forefoot. Clin. Orthop., 122:18, 1977.
4.
. ArangioG.A.: Proximal diaphyseal fractures of the fifth metatarsal (Jone's fractures): two cases treated by cross-pinning with review of 106 cases. Foot Ankle, 3(5):293–296, 1983.
5.
. CarpL.: Fractures of the fifth metatarsal bone with special reference to delayed union. Ann. Surg., 86:308–320, 1927.
6.
. CokerT.P.: Sports injuries to the foot and ankle. In Disorders of the Foot and Ankle. JahssM.H. (ed.), Philadelphia, W. B. Saunders, 1991.
7.
. DameronT.B.: Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J. Bone Joint Surg., 57A:788–792, 1972.
8.
. DeLeeJ.C.: Fractures and dislocations of the foot. In Surgery of the Foot. MannR.A. (ed.), St Louis, C. V. Mosby, 1986.
9.
. DeLeeJ.C.EvansJ.P.JulianJ.: Stress fractures of the fifth metatarsal. Am. J. Sports Med., 5:349–353, 1983.
10.
. DevasM.B.: Stress Fractures in Athletes. Edinburgh, Churchill Livingstone, 1975, pp. 1–8, 163–166.
11.
. GouldN.TrevinoS.: Sural nerve entrapment by avulsion fracture of the base of the fifth metatarsal bone. Foot Ankle, 2:153, 1981.
12.
. GrossT.S.BunchR.P.: A mechanical model of metatarsal stress fractures during distance running. Am. J. Sports Med., 17(5):669–674, 1989.
13.
. HansenS.T.: Foot injuries. In Skeletal Trauma. BrownerB.D. (ed.), Philadelphia, W. B. Saunders, 1992, pp. 1984–1986.
14.
. HeckmanJ.D.: Fractures of the foot. In Fractures in Adults, Vol 2. RockwoodC.A. (ed.), Philadelphia, J. B. Lippincott, 1991, pp. 2155–2159.
15.
. HensJ.MartensM.: Surgical treatment of Jones fractures. Arch. Orthop. Trauma. Surg., 109(5):277–279, 1990.
16.
. JonesR.: Fracture of the base of the fifth metatarsal by indirect violence. Ann. Surg., 35:697–700, 1902.
17.
. KavanaughJ.H.BrowerT.D.MannR.V.: The Jones fracture revisited. J. Bone Joint Surg., 60A:776–782, 1978.
18.
. LaurichL.J.WittC.S.ZielsdorfL.M.: Treatment of fractures of the fifth metatarsal base. J. Foot Surg., 22:207–211, 1983.
19.
. LehmanR.C.TorgJ.S.PavlovH.DeLeeJ.C.: Fractures of the base of the fifth metatarsal distal to the tuberosity: a review. Foot Ankle, 7(4):245–252, 1987.
20.
. LevyJ.M.: Stress fractures of the first metatarsal. Am. J. Radiol., 130:679–681, 1978.
21.
. LichtblauS.: Painful nonunion of a fracture of the fifth metatarsal. Clin. Orthop., 59:171–175, 1968.
22.
. McKeeverF.M.: Fractures of tarsal and metatarsal bases. Surg. Gynecol. Obstet., 90:735–745, 1950.
23.
. MeurmanK.O.A.: Less common stress fractures of the foot. Br. J. Radiol., 54:1–7, 1981.
24.
. MyersonM.S.: Injuries to the forefoot and toes. In Disorders of the Foot and Ankle. JahssM.H. (ed.), Philadelphia, W. B. Saunders, 1991, pp. 2258–2263.
25.
. PeasonJ.R.: Combined fractures of the base of the fifth metatarsal and the lateral malleolus. J. Bone Joint Surg., 43A(4):513–516, 1961.
26.
. PearsonJ.B.: Fractures of the base of the metatarsal. Br. Med. J., 1:1052–1054, 1962.
27.
. PeltierL.F.: Eponymic fractures: Robert Jones and Jones' fracture. Surgery, 71:522–526, 1972.
28.
. PritschM.HeimM.TauberH.HoroszowskiH.: An unusual fracture of the base of the fifth metatarsal bone. J. Trauma, 20(6):530–531, 1980.
29.
. ReinherzR.P.SinkC.A.WesterfieldM.: Management of trauma to the fifth metatarsal bone. Foot Surg., 28(4):301–307, 1989.
30.
. RettigA.C.ShelbourneD.K.WilckensJ.: The surgical treatment of symptomatic nonunions of the proximal (metaphyseal) fifth metatarsal in athletes. Am. J. Sports Med., 20(1):50–54, 1992.
31.
. RichliW.R.RosenthalD.J.: Avulsion fractures of the fifth metatarsal: experimental study of pathomechanics. A. J. R., 143:889–891, 1984.
32.
. SarrafianS.K.: Anatomy of the Foot and Ankle. Philadelphia, J. B. Lippincott, 1983, pp. 185–187.
33.
. ShereffM.J.YangQ.M.KumnerF.J.FreyC.C.GreenridgeN.: Vascular anatomy of the fifth metatarsal. Foot Ankle, 11(6):350–353, 1991.
34.
. SmithJ.W.AmoczkyS.P.HershA.: The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing. Foot Ankle, 13(3):143–152, 1992.
35.
. StewartI.M.: Jones' fracture: fracture of the base of the fifth metatarsal. Clin Orthop., 16:190–198, 1960.
36.
. TorgJ.S.: Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics, 13(7):731–737, 1980.
37.
. TorgJ.S.BalduiniF.C.ZelkoR.R.PavlovH.PeffT.C.DasM.: Fractures of the base of the fifth metatarsal distal to the tuberosity. J. Bone Joint Surg., 66A(2):209–214, 1984.
38.
. WilsonD.W.: Fractures of the foot. In The Foot and Its Disorders. KlenermanL. (ed.), Boston, Blackwell Scientific Publications, 1991, pp. 237–238.
. ZelkoR.R.TorgJ.S.RachunA.: Proximal diaphyseal fractures of the fifth metatarsal—treatment of the fractures and their complications in athletes. Am. J. Sports. Med., 7(2):95–101, 1979.
41.
. ZogbyR.G.BakerB.E.: A review of nonoperative treatment of Jones' fractures. Am. J. Sports Med., 15(4):304–307, 1987.
