Jones Fracture of Fifth Metatarsal
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Direct answer
A Jones fracture is a break of the fifth metatarsal at the metaphyseal-diaphyseal junction, a watershed zone with a poor blood supply that heals slowly. Ordinary low-demand cases are managed with a non-weight-bearing cast, whereas athletes are usually offered intramedullary screw fixation to shorten the time to return to sport.
What you must remember
- Zone 1: an avulsion of the tuberosity at the base, usually from traction by the lateral band of the plantar aponeurosis and peroneus brevis, which heals well with a cast or boot.
- Zone 2: the metaphyseal-diaphyseal junction, which is the true Jones fracture and has a watershed blood supply with poor healing potential.
- Zone 3: a stress fracture of the proximal diaphysis, seen with repetitive loading in runners and dancers.
- Watershed zone: the vessels supplying the proximal shaft meet at a poorly vascularised area, the main reason for delayed union.
- Mechanism: forefoot adduction with plantar flexion in a sudden twisting injury, or repetitive loading in athletes.
- Athletes: intramedullary cannulated screw fixation allows earlier return to sport, and it is preferred in most series of high-demand patients.
- Low-demand patients: a non-weight-bearing cast for a stable zone 2 fracture, with healing followed on serial radiographs.
Where the exam tries to catch you
Jones fracture questions test whether the candidate identifies the zone before choosing the treatment.
- Trap: calling every fifth metatarsal base fracture an ankle sprain. Correct: a Jones fracture is a zone 2 injury that needs imaging and often a period of non-weight bearing.
- Trap: treating a zone 1 avulsion like a Jones fracture. Correct: a tuberosity avulsion heals well with a cast or boot and does not need the same fixation.
- Trap: choosing a cast for an elite athlete with a zone 2 fracture. Correct: intramedullary screw fixation is preferred, because it shortens the time to return to sport and lowers the risk of nonunion in most series.
Frequently asked questions
What is a Jones fracture of the fifth metatarsal?
A Jones fracture is a fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction, which is zone 2 in the Lawrence and Botte scheme. It is prone to delayed union and nonunion because of its poor blood supply.
Why do Jones fractures heal slowly?
Jones fractures heal slowly because the metaphyseal-diaphyseal junction of the fifth metatarsal sits in a watershed zone with limited blood supply. Repetitive loading at that point also contributes to delayed union and nonunion.
How are Jones fractures treated in athletes?
Jones fractures in athletes are usually treated with intramedullary screw fixation, which allows an earlier return to sport than a prolonged cast. A period of non-weight bearing and radiographic follow-up still follow the surgery.
How does a zone 1 fifth metatarsal fracture differ from a Jones fracture?
A zone 1 fracture is an avulsion of the tuberosity, usually from traction by the lateral band of the plantar aponeurosis and peroneus brevis, and it heals well with a cast or boot. A Jones fracture lies at the metaphyseal-diaphyseal junction, where healing is slower and the treatment is more involved.