The Jones Fracture

Fractures of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction can be a particularly troublesome clin-ical problem to deal with, especially in the athletic population. Sir Robert Jones is credited with first describ-ing this fracture in 1902, after reporting a series of 4 such cases, including 1 he incurred himself while dancing and “treading on the outside side ” of his foot.10 This fracture has subsequently been referred to as the Jones fracture and has been identified as a fracture at risk for delayed union, nonunion, and refracture.1,5 It is thought that the poor blood supply to this region of the fifth metatarsal accounts for the tendency toward delayed union.20,24 Although many of these fractures do have an acute com-ponent, many if not most are superimposed on chronic stress injury to the bone.21 This explains the bony sclerosis and hypertrophic bone formation that are often seen on radiograph, even immediately after an acute twisting injury. The mechanism of injury is described as a laterally directed force on the forefoot during plantar flexion of the ankle.14 Examples include pivot shifting in football or bas-ketball with the heel off the ground. Those at greatest risk for suffering this type of fracture include younger athletes with a high level of activity in a running and/or jumping sport. It is also thought that those with hindfoot varus of any cause have a predilection toward this fracture because of lateral column overloading.4 The fracture most com-monly occurs in the young athletic population and fre-quently in elite athletes