Fifth metatarsal fractures: an update on management, complications, and outcomes

Abstract

Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term 'Jones' fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient's needs and the 'personality' of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the 'gold standard' of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

Keywords: fifth metatarsal; fracture; review; treatment.

Figure 1

Schematic drawing showing the pertinent anatomy of the fifth metatarsal including Zones 1, 2, and 3. Zone 1 involves the tuberosity, Zone 2 the 4–5 intermetatarsal articulation (arrows), and Zone 3 is within 1.5 cm of the proximal metaphysis. (Obtained with permission from George D. Chloros, MD.)

Figure 2

Vascular supply of the fifth metatarsal showing the watershed area in Zone 2 (gray). (Obtained with permission from George D. Chloros, MD.)

Figure 3

Conservatively managed Zone 1 injury. (A) Injury anteroposterior, oblique, and lateral radiographs showing a Zone 1 injury. (B) At 6 weeks, the patient went into a fibrous painless union. (Obtained with permission from George D. Chloros, MD.)

Figure 4

(A) Pre-operative anteroposterior and oblique radiographs showing a Zone 3 injury. (B) Intra-operative fluoroscopic images showing placement of an intramedullary screw. (C) Post-operative anteroposterior and oblique radiographs at 3 months showing complete healing. (Obtained with permission from George D. Chloros, MD)

Figure 5

(A) Post-operative view of a relatively small, thin intramedullary screw. (B) A 2-month post-operative radiograph demonstrates hardware failure. (Obtained with permission from George D. Chloros, MD)