Jone's fracture by Dr.Mahbub

WELCOME Short Notes Presentation

JONES FRACTURE

Dr. Sheikh Golam Mahbub

D(Ortho)Student

Orthopaedics Surgery

BSMMU

What is Jones Fracture ?

The Jones fracture is defined as a fracture 1.5 cm distal to the tuberosity of the 5th meta tarsal base in which the main fracture line extend in to the 4th-5th metatarsal articulations.

Why it is called jones fracture ?

First described in 1902 by orthopedic surgeonSir Robert Jones.

He sustained the injury himself(while dancing) as a fracture of the 5th metatarsal about three-fourths ofan inch from its base.

Anatomy

The peroneus brevis tendon and lateral band of the plantar fascia insert onto the base of the fifth metatarsal.

There is a relative watershed in the blood supply to the 5th metaTarsal at the junction between the diaphysis and metaphysis.

Continue…

Proximally, affecting the tuberosity, in the region of articulation with the fourth metatarsal, or at the metaphyseal/diaphyseal junction.

Higher rate of non-union, probably as a consequence of the relatively poor blood supply in that region.

Mechanism Of Injury

The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion

Clinical Presentation

Pain over this middle/outside area of foot

Swelling

Difficulty Walking

Radiological Findings Diagnostic x-rays include anteroposterior, oblique, and lateral views and should be

made with the foot in full flexion.

X-Ray shows a transverse fracture near the metatarsal base , usually small fragment & Minimally displaced.

Should not be confused with normal apophysis of the proximal 5th metatarsal.

Classification of fracture(According to site)

Classification of Fracture of 5th Metatarsal

Type Description I Acute fractures at the metaphyseal-diaphyseal junction. IA Nondisplaced IB Displaced or comminuted or both. II Fractures at the metaphseal-diaphyseal junction with clinical or

radiographic evidence of previous injury (i.e., pain, sclerosis).

III Fractures of the styloid process of the fifth metatarsal. IIIA Without involvement of the fifth metatarsocuboid joint. IIIB With involvement of the fifth metatarsocuboid joint.

Differntial Diagnosis Avulsion Fracture Os Peroneum Diaphyseal Stress Fractures

Treatment

Non Surgical Until you are able to see a foot & ankle surgeon. the “R.I.C.E” method of care should be performed REST : Stay off the injured foot ICE: Apply an icepack to the injured area COMPRESSION: An elastic wrap should be used to control swelling ELEVATION: The foot should be raised above the level of Heart to reduce swelling If a jones fractures is not significantly displaced, it can be treated with a

cast,splint or walking boot for 4 to 8 weeks.

When is Surgery Needed

Zone 1  treated without surgery cast, boot or hard-soled shoe heal within six to eight weeks.

Zone 2 higher chance of nonunion risk of refracture even after healing. Surgical treatment is common.

Zone 3  typically stress fractures in athletes risk of refracture may be reasons for surgical repair in

these fractures.

Type l Fractures

Type IA fracture (acute) Non–weight bearing, Short leg cast is worn for 6 to 8 weeks followed by a weight bearing

cast until union has been achieved Type IB fractures with displacement and comminuted

In competitive athletes, consideration should be given to early open reduction and internal fixation to decrease disability time.

use of electrical and pulsed ultrasound and bone stimulation for may improve healing of the fracture.

Surgery should be considered for type I fractures that are not healing clinically at 8 to 12 weeks

Type ll Fractures

Type II fractures (partial or complete canal obliteration and sclerosis) Non–weight bearing casting may yield satisfactory results. Immobilization and non–weight bearing is approximately 8

weeks. Refracture is common in this category

Surgery should be considered for type II fractures in competitive athletes and others whose occupational demands do not allow prolonged non–weight bearing immobilization

Type lll Fractures

Type III fractures Short leg cast for 3 weeks followed by a well-molded arch

support.

Nonunions of type III fractures may occur, they rarely are painful and can be treated with excision of the fragment

Surgical Treatment Fixation with a medullary 4.5-mm malleolar screw Corticocancellous in lay bone grafting with clearing of the medullary canal of all

sclerotic bone 5.5-mm and larger cannulated screws, and non cannulated screws with low-profile

heads.  Fractures of the shaft of the metatarsal are typically fixed with a plate and screws

Surgical Approach

Incision through skin only• 1 fingerbreadth proximal to base of 5th MT• Parallel to peroneals

Supine position Flex knee and place foot on base

Post operative care

A well-padded, short-leg, non-walking cast, extending to the toes, is applied.

Non weight bearing for 2 weeks. Weight bearing in a cast may be started 2 weeks postoperatively. Ankle ROM against gravity abduction/adduction, planter and

dorsiflexion. Return to competitive sports is usually takes 10 to 12 weeks.

Complications

Refracture Screw Failure Non union Infection Sural nerve injury Hardware discomfort

Conclusions

The Jones fracture presents a dilemma in treatment of the active patient.

Jones fracture has a high rate of nonunion due to low vascular integrity. Though cast treatment has been shown to be effective, early screw

fixation of the Jones fracture will results in shorter times to union & return to activity.

Operatively treated Jones fracture have a high success rate. Athlete should not be allowed to return to full activity until full

radiographic union is evidenced. Even with non–weight bearing immobilization for 6 to 8 weeks, type I

fractures have a reported nonunion rate of 7% to 28%.