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Pseudo Jones Fracture

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Page 1: Pseudo Jones Fracture
Page 2: Pseudo Jones Fracture

46 YOM pw pain in right foot. Pain began this morning when he woke up. Pt reports playing a lot of basketball yesterday but denies trauma. Pain is located on side of his foot near his small toe, described as severe and exacerbated by walking. No relievers reported.

T 97.2 P 115 BP 126/84 O2 99%

Gen: Mild discomfort 2/2 pain in foot. GCS 15

CV: Tachycardic, RR, no m/r/g

Pulm: Lungs CTA bilatAbd: NTND/BS nLMSK: No bony

abnormalities on feet bilaterally. LE bilaterally NV intact. TTP at base of 5th MT (R) w decreased ROM 2/2 pain. No TTP malleoli or calcaneus (R).

Page 4: Pseudo Jones Fracture

1. Orange arrow: linear, non-displaced fracture at proximal 5th MT2. Fracture is MT tuberosity.3. No fracture seen at metaphyseal-diaphyseal junction (Jones

fracture)

Page 5: Pseudo Jones Fracture

Ice, Analgesics, ElevatePlace in hard soled shoeCrutches optional based on severity of pain

but pt does not have to be non-weight bearing.

Follow up with Orthopedics in 1-2 weeks.

Page 6: Pseudo Jones Fracture

Pseudo-Jones fracture is an avulsion fracture of the base of the 5thmetatarsal involving the tuberosity

• Pseudo-Jones fracture is the most common fracture of the base of the 5th

metatarsal, accounting for over 90% of 5th Metatarsal fractures

• Avulsion at the attachment site of the peroneus brevis • Should not be confused with a Jones fracture as treatment is

different. • Patient's with Pseudo-Jones fracture are allowed to bear weight

while patient's with Jones fractures can not. • A Jones fracture is a fracture of the base of the 5th metatarsal at

the metaphyseal-diaphyseal junction. • Jones fracture, although they can be treated with a short leg cast,

nonunion is a concern with a Jones fracture, and hence, they may eventually require screw fixation.

Page 7: Pseudo Jones Fracture

This is an avulsion fracture of the 5th MT tuberosity.

MOI: forcible inversion of the foot in plantar flexion.( A direct blow to the tuberosity can cause a comminuted fracture.)

The fracture occurs where a the peroneus brevis tendon tendon attaches to the bone.

Treatment: Hard soled boot, f/u with Ortho in 1-2 weeks.

Also called a Dancer’s Fracture

Page 8: Pseudo Jones Fracture

A Jones fracture occurs at the proximal end of the metatarsal near the metadiaphyseal junction (greater than 15 mm distal to the proximal end of the 5th metatarsal).

MOI: Typically a result of an upward force or a direct blow to the area.

Jones fracture often does not heal bc this is an area of poor blood supply. And, there are various tendons attaching in the area pulling the fracture apart causing motion at the site of healing.

Treatment: Immobilize, strict non-weight bearing, f/u with Ortho in 5-7 days

Page 9: Pseudo Jones Fracture

Tintinalli's Emergency Medicine: A Comprehensive Study Guide. O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski, David M. Cline. McGraw-Hill Professional Publishing: 2010.

Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.

Radiographics. Forefoot Pain Involving the Metatarsal Region: Differential Diagnosis with MR Imaging. Carol J. Ashman, MD, Rosemary J. Klecker, MD and Joseph S. Yu, MD: 2001.

Skimboarder's Toe: Findings on High-Field MRI Am. J. Roentgenol. May 1, 2005 184:5 1481-1485.