The document discusses Jones fractures, which are fractures of the fifth metatarsal bone. It defines Jones fractures, explains their anatomy and blood supply, mechanisms of injury, classification, treatment options including casting, surgery, and post-operative care. Jones fractures have a high rate of non-union due to the area's poor blood supply and are challenging to treat, especially in active patients. Surgical fixation may allow for shorter recovery times compared to casting alone.

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%.