One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.įractures in zones I and II should be treated with early functional therapy. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. 46 days p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. The non-randomized studies revealed a faster return to full function (33 vs. 28 days p = 0.001), with otherwise similar outcomes. Two of these were randomized controlled trials (RCTs) in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. Nine studies compared different treatments of zone I fractures. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture. ![]() The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones zone II, in the area of the joint zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Nevertheless, no evidence-based treatment recommendations are available to date. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. doi:10.5312/wjo.v7.i12.Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Fifth Metatarsal Fractures and Current Treatment. Zone II and III Fifth Metatarsal Fractures in Athletes. A Look Back in Time: Sir Robert Jones, 'Father of Modern Orthopaedics'. Fractures of Proximal Portion of Fifth Metatarsal Bone: Anatomic and Imaging Evidence of a Pathogenesis of Avulsion of the Plantar Aponeurosis and the Short Peroneal Muscle Tendon. Theodorou D, Theodorou S, Kakitsubata Y, Botte M, Resnick D. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Avulsion Fracture of the Base of the Fifth Metatarsal Not Seen on Conventional Radiography of the Foot: The Need for an Additional Projection. Distinguishing Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal. Chuckpaiwong B, Queen R, Easley M, Nunley J. Internal fixation and even bone grafting may be required in cases of non-union, or where the fracture is significantly displaced. The outcomes are similar with almost 100% union rates 7. ![]() Management includes either intramedullary screw fixation or open reduction and internal fixation (ORIF is also the main management option as a salvage procedure when there is non-union following screw fixation) 7. Operative management is indicated in patients that are elite or competitive athletes or in non-operatively managed fractures when delayed union has occurred 7,8. Relative to avulsion fractures, Jones fractures are particularly prone to non-union (with rates as high as 30-50%) due to being in a vascular watershed zone, and almost always take longer than two months to heal 2.ĭisplacement of the fracture can increase with persistent weight-bearing, therefore, immobilization is important as part of the initial therapy, with a non-weight bearing cast for 6-8 weeks. Indications for non-operative management include undisplaced fractures and fractures in patients with limited activity (i.e. ![]() Jones fracture is located at the metadiaphyseal junction, approximately 2 cm (1.5-3 cm) from the tip of the 5 th metatarsal, and has a predominantly horizontal course. Radiographic features Plain radiograph/CT The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion 5. It is a transverse fracture at the base of the fifth metatarsal, 1.5 to 3 cm distal to the proximal tuberosity at the metadiaphyseal junction, without distal extension.
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