Anatomy Msk · Year 1 · from Anatomy Msk
Case 3: Fifth Metatarsal Fractures
Clinical Image
Source: Wikimedia Commons - Jones Fracture - CC BY-SA 3.0
Case Presentation
A 25-year-old professional basketball player presents with lateral foot pain after landing awkwardly from a jump during practice. He reports immediate pain at the base of his fifth metatarsal and was unable to continue playing. He denies any prior foot injuries or pain at this location. Physical examination reveals point tenderness at the proximal fifth metatarsal, specifically in the metaphyseal-diaphyseal junction, rather than at the tuberosity. There is mild swelling over the lateral midfoot. He is unable to bear weight on the affected foot. Radiographs demonstrate a transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, which is a true Jones fracture. There is no fracture of the tuberosity and no avulsion at the base. Given his athletic demands and the high nonunion rate of Jones fractures with conservative treatment, he undergoes intramedullary screw fixation. He is kept non-weight-bearing for 4 weeks, then progressed to weight bearing, and returns to full basketball activity at 10 weeks.
Key Learning Points
- Fifth metatarsal fractures are classified by location: Zone 1 (tuberosity avulsion), Zone 2 (Jones fracture), Zone 3 (shaft stress fracture)
- Jones fracture occurs at the metaphyseal-diaphyseal junction, a watershed zone with poor blood supply
- Jones fractures have high nonunion rates (up to 30%) with conservative treatment due to limited vascularity
- Tuberosity avulsion fractures (Zone 1) result from peroneus brevis traction and heal well conservatively
- Athletes with Jones fractures often undergo operative fixation for faster return to sport and lower refracture rates