Fifth metatarsal fractures

Last evidence check May 2011


The basic classification is:

Fractures of the proximal metatarsal are often referred to as "Jones fractures". There is some controversy as to the best sub-classification of this zone. There is definitely a region just distal to the tuberosity in which fractures are more likely to go on to non-union, probably as a result of the stress riser effect and possibly the vascular watershed. Some authors classify all fractures proximal to this zone together. Others (Lawrence + Botte 1993) separate a group in which the fracture line is at the level of the 4th-5th intermetatarsal joint, calling these "true Jones fractures". Chuckpaiwong (2008) analysed 61 proximal metaphyseal/diaphyseal junction fractures. The examined two possibly distinct groups:

There were no differences in the epidemiology, outcomes or adverse events between these groups. Just over half the patients were athletes. 4/25 fractures that were initially treated non-surgically failed to unite. It is difficult to interpret this study for a number of reasons. 37 patients were operated on primarily, mainly because they were athletes. The proximal extent of a fracture for inclusion is not very clear in this study, and their definitions are not exactly those of Lawrence and Botte. However, this study suggests that fractures in the zones labelled in the diagram "stress fractures" and "true Jones" fractures may not be clinically distinct groups.

The Hyperbook therefore uses the following classification: