Jones fracture
| Jones fracture | |
|---|---|
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| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | S92.3 |
| ICD-9-CM | 825.25, 825.35 |
| eMedicine | radio/850 |
A Jones fracture is a fracture in the meta-diaphyseal junction of the fifth metatarsal of the foot. The proximal end of the metatarsal, where the Jones fracture occurs, is near the midportion of the foot, on the fifth ray (of which the 5th toe belongs). Those who sustain a Jones fracture have pain over this area, swelling, and difficulty walking. The fracture was first described by orthopedic surgeon Sir Robert Jones who sustained this injury himself (while dancing) and reported it in the Annals of Surgery in 1902.
A patient with a Jones fracture may not realize that a fracture has occurred. Diagnosis includes the palpation of an intact peroneus brevis tendon, and demonstration of local tenderness distal to the tuberosity of the fifth metatarsal, and localized over the diaphysis of the proximal metatarsal. Bony crepitus is unusual.
This injury should be differentiated from the developmental apophysis (5th metatarsal tuberosity) commonly and normally occurring at this site in adolescents. Differentiation is possible by characteristics such as absence of sclerosis of the fractured edges (in acute cases) and orientation of the lucent line: transverse (at 90 degrees) to the metatarsal axis for the fracture (due to avulsion pull by the peroneus brevis muscle inserting at the proximal tip) - and parallel to the metatarsal axis in the case of the apophysis. Diagnostic x-rays include anteroposterior, oblique, and lateral views and should be made with the foot in full flexion.
A legitimate concern in any fracture is whether the fracture will heal quickly and without complication. Failure of the fractured ends to unite is called non-union and its frequency varies with the fracture site, some fracture sites being notorious for non-union. An example of such would be a scaphoid (navicular) fracture of the wrist. Such a complication also involves fractures of the proximal end of the fifth metatarsal, such as the Jones fracture. This has been the subject of interest, and initially led to the description of three zones at the proximal end of the fifth metatarsal.
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