Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: A Review

Fractures of the proximal part of the fifth metatarsal can be separated into two types: (1) those involving the tuberosity, and (2) those involving the proximal part of the diaphysis distal to the tuberosity. Recently it has been recognized that the latter group, Jones' fractures, may be difficult to treat. Although reports in the literature have indicated the potential difficulties in the treatment of Jones' fractures, prevailing guidelines for their management are ambiguous. Apparently the varied clinical and roentgenographic manifestations of these fractures have not been correlated with their response to treatment. In this paper we describe a classification of these fractures and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions. The treatment of choice for acute fractures is immobilization of the limb in a toe to knee cast with nonweightbearing. Fractures with delayed union may eventually heal if they are treated conservatively, but an active athlete with delayed union or an established nonunion will benefit from operative intervention. The procedures of choice are (1) medullary curettage and bone grafting, and (2) closed axial intramedullary screw fixation using a 4.0-mm ASIF malleolar screw.