Types: Based on landmarks along joint between 4th and 5th metatarsals proximally
1. Tuberosity Avulsion Fractures (Styloid Fractures)
  1. Proximal to the joint between 4th and 5th metatarsals
  2. Mechanism: Lateral Ankle Sprain (inversion injury while foot plantar flexed)
  3. Typically heal without complications
2. Metaphyseal-Diaphyseal Junction Fractures (Jones Fracture)
  1. Fracture line extends toward the joint between 4th and 5th metatarsals
  2. Mechanism: Sudden "cutting" motion side-to-side while the heel is off the ground
  3. High risk area for non-healing Fractures
3. Diaphyseal Stress Fractures
  1. Distal to the joint between 4th and 5th metatarsals
  2. Mechanism: Recurrent trauma such as jumping and pivoting in young athletes
  3. Highest risk area for non-healing Fractures
Symptoms
1. Distribution: Lateral Foot Pain
2. Provocative: Walking
3. Timing:
  1. Acute Fractures: Sudden onset
  2. Stress Fractures: Gradually progressive and increased with activity
Signs
1. Localized swelling and Ecchymosis at the base of the fifth metatarsal
Imaging: XRay demonstrates Proximal Fifth Metatarsal Fracture
1. See Proximal Fifth Metatarsal Fracture Grading Based on XRay
2. See Types above for determining Fracture type
3. Differential diagnosis on XRay of proximal fifth Metatarsal Fracture look-alikes
  1. Accessory bones (smooth, rounded densities surrounded by cortex)
  2. Styloid apophysis (children and teens)
Management: Tuberosity Avulsion Fractures (Styloid Fractures)
1. Indications for orthopedic referral
  1. Displaced tuberosity avulsion Fractures
  2. Nonunion Fractures
  3. Cuboid-metatarsal joint with >1-2 mm step-off
2. Protocol for uncomplicated, non-displaced tuberosity avulsion Fractures
  1. Option 1
    1. Soft Bulky Dressing and weight bearing
  2. Option 2 (if pain despite Option 1)
    1. Hard soled shoe or cast boot and weight bearing
  3. Option 3 (if pain despite Option 2)
    1. Short leg walking-cast
3. Course
  1. Anticipate asymptomatic by 3-6 weeks
  2. Anticipate healed with union on XRay by 8 weeks
Management: Diaphyseal Fractures (Jones Fracture or Diaphyseal Stress Fractures)
1. Indications for orthopedic referral
  1. See Fifth Metatarsal Fracture for absolute referral indications
  2. Consider consultation in all patients given higher risk of non-union
  3. Athletes may also benefit from referral by decreasing duration of healing time
2. Options: Non-displaced Jones Fracture (acute diaphyseal Fracture)
  1. Non-weight bearing short-leg cast for 6-8 weeks or
  2. Weight-bearing orthosis for 8-12 weeks or
  3. Consider early surgical fixation in athletes
3. Options: Diaphyseal Stress Fracture Type I (early, See Torg Classification)
  1. Same management for Jones Fracture above
4. Options: Diaphyseal Stress Fracture Type II (delayed, See Torg Classification)
  1. Early surgical fixation or
  2. Non-weight bearing cast for up to 20 weeks
5. Options: Diaphyseal Stress Fracture Type III (nonunion, See Torg Classification)
  1. Surgical fixation or
  2. Non-weight bearing cast for up to 16 weeks and pulsed electromagnetic fields
    1. Holmes (1994) Foot Ankle Int 15:552
6. References
  1. Dameron (1995) J Am Acad Orthop Surg 3:110
References
1. Hatch (2007) Am Fam Physician 76:817
2. Quill (1995) Orthop Clin North Am 26:353

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This page was written by Scott Moses, MD. This page was last revised on 11/11/2007 8:17:33 AM. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.