$displaced 5th metatarsal fracture$

$displaced 5th metatarsal fracture$

The physician may advance weight-bearing status as radiographic evidence of bone healing appears. Nondisplaced zone 2 injuries, or Jones fractures, may also be treated conservatively with 6 to 8 weeks of non-weight bearing in a short leg cast. Fractures involving 30% of the articular surface or with an articular step-off over 2 mm have treatment with open reduction, internal fixation, closed reduction, and percutaneous pinning or excision of the fragment. Progression to weight-bearing as tolerated can initiate as pain and discomfort subside over 3 to 6 weeks. Nondisplaced zone 1 injuries can be treated conservatively with protected weight-bearing in a hard-soled shoe, walking boot, or walking cast. Treatment decisions have their basis on the anatomic zone of injury, the social and medical history of the injured patient, and evidence of radiographic signs of healing. A vascular watershed area exists in zone 2, contributing to the high nonunion rates seen with these fractures. Metaphyseal arteries and diaphyseal nutrient arteries provide the blood supply to the fifth metatarsal base. Additionally, a patient may sustain a shaft fracture greater than 1.5 cm distal to the tuberosity, a long spiral fracture extending into the distal metaphyseal area, the so-called dancer's fracture, or a stress fracture of the metatarsal.Ĭlassification of these fractures is crucial to making management decisions. Fractures through zone 1 are called pseudo-Jones fractures, and fractures through zone 2 are referred to as Jones fractures. Nevertheless, it is critical that the clinician recognizes all injury patterns of the fifth metatarsal and initiate the appropriate treatment plan or referral process to avoid potential complications.Ĭlassified by Lawrence and Bottle, the base, or proximal aspect, of the fifth metatarsal is broken up into three anatomical zones: zone 1, the tuberosity zone 2, the metaphyseal-diaphyseal junction and zone 3, the diaphyseal area within 1.5 cm of the tuberosity. Since orthopedic surgeon Sir Robert Jones first described these fractures in 1902, there has been an abundance of literature focused on the proximal aspect of the fifth metacarpal due to its tendency towards poor bone healing. Fractures of the fifth metatarsal are common injuries that must be recognized and treated appropriately to avoid poor clinical outcomes for the patient.

$displaced 5th metatarsal fracture$

Displaced 5th metatarsal fracture