Description

Jones Fracture: Fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, without joint involvement. Caused by foot inversion / twisting and repetitive stress

The term ‘Jones fracture’ is used inconsistently; some referring to fracture at the metaphyseal-diaphyseal junction and others define it as a fracture at the proximal diaphysis.

The ‘Zone I, II, III‘ method of description is more accurate, replicable and assists in determining immediate treatment and ongoing management.

History

1902 – Sir Robert Jones, general surgeon with a passion for orthopaedics and radiology, sustained this injury whilst dancing. In 1902 he wrote up a case report of five similar injuries specifically noting that the fracture is caused by ‘indirect violence’

Whilst dancing, I trod on the outer side of my foot, my heel at the moment being off the ground. Something gave way midway down my foot, and I at once suspected a rupture of the peroneus longus tendon…The following morning I carefully examined my foot and discovered that my tendon was intact. There was a slight swelling over the base of the fifth metatarsal bone… A finger on the spot gave exquisite pain…Extension of the ankle and flexion of the toes were immediately felt at the base of the fifth metatarsal. I hobbled down-stairs to my colleague…to X-ray my foot. This was done, and the fifth metatarsal was found fractured about three-fourths of an inch from its base.

Jones R, Ann Surg. 1902: 697

1960 – Stewart differentiated an avulsion fracture of the tuberosity / styloid from fractures of the proximal diaphysis. He named the latter: ‘Jones fracture’.

1984 – Torg et al report fractures of proximal diaphysis are likely located at a site of pre-existing stress pressure.

1993 – Lawrence and Botte release a classification system distinguishing 3 zones

• Zone 1: Tuberosity avulsion fracture, with or without involvement of the tarsometatarsal articulation. Caused by forces by the peroneus brevis tendon or the lateral band of the plantar fascia during foot inversion.
• Zone 2: Jones fracture; metaphysis-diaphysis junction fracture, which extend into the fourth-fifth intermetatarsal facet. Caused by forced forefoot adduction with the hindfoot in plantar flexion.
• Zone 3: Diaphyseal stress fracture; proximal diaphyseal fractures, distal to the fourth and fifth metatarsal base articulation. Caused by acute excessive bearing of the region or chronic overloading as in stress fractures

Associated Persons

• Sir Robert Jones (1857-1933)

Alternative names

• Zone II 5th Metatarsal fracture

References

• Jones R. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann Surg. 1902;35(6):697–700
• Stewart IM. Jones’s fracture: fracture of base of fifth metatarsal. Clin Orthop. 1960;16:190-8.
• Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984 Feb;66(2):209-14.
• Lawrence SJ, Botte MJ. Jones’ fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993 Jul-Aug;14(6):358-65.
• Torg JS. Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics. 1990;13(7):731–7.
• Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66(2):209–14
• Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int. 2006 Mar;27(3):172-4.
• Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury. 2010 Jun;41(6):555-62.
• Polzer H, Polzer S, Mutschler W, Prall WC. Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury. 2012 Oct;43(10):1626-32
• Cheung CN, Lui TH. Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications. Arch Trauma Res. 2016 Dec; 5(4): e33298.
• Cadogan M. Eponymythology of foot injuries. LITFL