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Jones Fracture S92.353A 825.25

synonyms: Jones fracture, true Jones fracture, 5th metatarsal tuberosity fracture, Jones fracture nonunion. 5th metatarsal diaphyseal stress fracture

Jones Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

Jones Fracture ICD-9

  • 825.25 (closed fracture of metatarsal bone)
  • 825.35 (open fracture of metatarsal bone)

Jones Fracture Etiology / Epidemiology / Natural History

  • True Jones fracture is in the proximal meta-diaphyseal junction of the 5th metatarsal base in which the main fracture line extends into the 4th-5th metatarsal articulation.
  • MOI: For true Jones Fracture believed to occur from a large adduction force applied to the forefoot with the ankle in plantarflexion. (Lawrence SJ, Foot Ankle 1993;14:358). Tuberosity avulsion fractures result from the pull of the Peroneus brevis or the lateral band of the plantar aponeurosis.

Jones Fracture Anatomy

  • relative avascularity of this area, a nonweightbearing cast is the treatment of choice. Zogby RG, Baker BE: A review of nonoperative treatment of Jones fracture.  Am J Sports Med 1987;15:304-307.
  • Base of the 5th MT has 2 articulations: (1)cuboid-fifth metatarsal articulation, (2)fourth-fifth intermetatarsal articulation.
  • Peroneus brevisinserts over a broad area on the dorsolateral aspect of the tuberosity.
  • Peroneus tertiusinserts into the dorsal surface of 5th metatarsal base.
  • Lateral band of the plantar aponeurosis inserts on the plantar surface of the styloid.
  • Os peroneum is a sesamoid bone in the Peroneus longus tendon near the proximal fifth metatarsal adjacent to the cuboid. Present in 15% of patients (Daeron TB Jr, JBJS 1975;57A:788).
  • Os vesalianum is an ossicle in the Peroneus brevistendon.Present in 0.1% of patients (Daeron TB Jr, JBJS 1975;57A:788). .
  • Secondary center of ossification appears between 9 and 11 years in girls and 11 and 14 in boys. Complete union with the shaft occus in less than 2 years.
  • Sural nerve and its terminal branches are at risk in surgery involving the peroneal tendon complex and the 5th metatarsal (Donley, Foot Ankle Int 20:182;1999)

Jones Fracture Clinical Evaluation

  • Patients with acute tuberosity avulsion fractures, or true Jones fractures complain of lateral foot pain and swelling after an injury.
  • Patients with diaphyseal stress fractures will complain of preceding pain in the lateral aspect of the foot.

Jones Fracture Xray / Diagnositc Tests

  • A/P, lateral and obliqueviews of the affected foot.
  • Acute fractures demonstrate sharp fracture lines without widening or radiolucency and minimal cortical hypertrophy.
  • Nonunions demonstrate wide fracture lines with periosteal new bone formation and obliteration of the medullary canal with intrameduallar sclerosis.

Jones Fracture Classification / Treatment

  • Zone 1; Nondisplaced Tuberosity Avulsion Fracture: common. Treatment = hard-soled shoe or walking cast until pain subsides. Generally heal in 8 weeks.
  • Zone 1; Displaced Tuberosity Avulsion Fracture(intra-articular extension with >2mm step-off): uncommon. Treatment = ORIF with screw or Kirschner wire fixation.
  • Zone 1; Symptomatic Tuberosity Avulsion Fracture Nonunion: Treatment = excision of small fragments which do not violate insertion of Peroneus brevis; ORIF for large fragments (Rettig AC, ALSM 1992;20:50).
  • Zone 1; Asymptomatic Tuberosity Avulsion Fracture Nonunion: Treatment = activity as tolerated.
  • Zone 2; Acute Nondisplaced True Jones Fracture: Treatment = non-weight-bearing short leg cast for 6 to 8 weeks. Consider initial intrameduallary screw fixationfor high level athletes (Mindrebo N.AJSM, 1993;:720), or if there is intramedullary sclerosis and a lucent fracture line at the 8 week follow-up.
  • Zone 2; Acute Displaced True Jones Fracture: Treatment = intrameduallary screw fixation.
  • Zone 2; True Jones Fracture Nonunion: Treatment = intrameduallary screw fixation.
  • Zone 3; Acute Nondisplaced Diaphyseal fracture: Treatment = non-weight-bearing short leg cast for 6 to 8 weeks. Consider initial intrameduallary screw fixationfor high level athletes, or if there is intramedullary sclerosis and a lucent fracture line at the 8 week follow-up.
  • Zone 3; Acute Displaced Diaphyseal Fracture: Treatment = intrameduallary screw fixation.
  • Zone 3; Diaphyseal Stress Fracture with neutral heel: Treatment = intrameduallary screw fixation.
  • Zone 3; Diaphyseal Stress Fracture with flexible cavovarus heel: Treatment = intrameduallary screw fixation of the 5th metatarsal with dorsiflexion osteotomy of the 1st metatarsal (DenHartog BD, JAAOS 2009;17:458).

Jones Fracture Associated Injuries / Differential Diagnosis

Jones Fracture Complications

  • Nonunion: 7-28% for acute true Jones fractures treated with non-weight bearing casts. (Rosenberg GA, JAAOS, 2000;8:332).
  • Delayed union:
  • Sural nerve palsy
  • Infection
  • Refracture
  • Painful hardware

Jones Fracture Follow-up Care

  • Non-operative treatment for acute true Jones fractures may take up to 21 weeks.
  • Median time to union = 7.5 weeks for screw fixation, 14.5 weeks for NWB casting. Median return to sports = 8.0 weeks for screw fixation, 15.0 weeks for NWB casting. (Mologne TS, AJSM, 2005;33:970),

Jones Fracture Review References

  • Instructional course lectures 93 vol 42:201, chapter 17; Sanunarco JG, The Jones Fracture
  • Rockwood and Green's Fractures in Adults 6th ed, 2006
  • Josefsson PO, Karlsson M, Redlund-Johnell I, et al: Jones fracture: Surgical versus nonsurgical treatment.  Clin Orthop 1994;299:252-255.
  • Torg JS, Balduini FC, Zelko RR, et al: Fractures of the base of the fifth metatarsal distal to the tuberosity: Classification and guidelines for nonsurgical and surgical management.  J Bone Joint Surg 1984;66A:209-214.
  • Rosenberg GA, JAAOS, 2000;8:332
  • Dameron TB Jr, JAAOS 1995;3:110
  • Quill GE JR, CORR 1995;26:353
  • Nunley JA, Orthop Clin NOrth Am, 2001;32:171
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