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A Jones fracture is a fracture of the base of the fifth metatarsal bone. It occurs near the base end (metphyseal-diaphyseal junction) and 1.5 to 3 cm distal to the base of 5th metatarsal. It is one of the most common fractures of this area. This area is the watershed area of blood supply, so the fracture usually disrupts the blood supply and therefore it takes a longer time to heal. It should not be confused with a much more common type of fracture, the so-called avulsion fracture, which can easily be managed conservatively and has fast healing.

The symptoms of a Jones fracture are: Pain, swelling, inability to bear weight on the foot and bruising.

It is diagnosed through X-ray, which shows the fracture line in the particular area.

Treating A Jones Fracture

In acute cases, the following universal regimen is followed:

  • Protect
  • Rest
  • Ice
  • Compression
  • Elevation

Specific treatment of jones fracture is usually divided into two categories:

  1. Conservative
  2. Surgery

The choice of treatment depends upon the type of fracture, thr displacement of the fracture, and activity demands of the patient.

Conservative Treatment

Most Jones fractures are managed conservatively. This involves an initial non-weight bearing, short leg cast. This cast is given for a period of six to eight weeks, after which it is usually converted into a weight-bearing cast. The patient's condition is followed through serial X-rays and the weight-bearing cast is removed after the radiological signs of union are seen. If they are not seen, you may have to wait a bit longer.

This type of management is most appropriate for non-displaced or minimally displaced fractures. Patients with low activity demands are also suitable candidates for conservative treatment as they can tolerate the non-weight bearing period. Chronic fractures which are present for more than eight weeks cannot be managed conservatively because of high non-union rate.

 

The reported nonunion rate of Jones fractures is seven to 28 percent, even in patients who had the non-weight bearing cast for eight weeks.

 

Surgery For Jones Fractures

Surgery is the treatment of choice for fractures don't heal after eight to 12 weeks of conservative treatment and in acute settings when the activity demands of the patient are high, such as for athletes. It should also be considered for patients who present late, meaning after eight weeks of injury.

Two operative techniques are proven successful in this kind of fracture:

  1. Fixation with an intramedullary screw
  2. Bone grafting

Surgery has certain advantages over conservative treatment:

  • Quicker time of healing
  • Early return to normal activity
  • Early weight bearing
  • Appropriate for both acute and chronic fractures

The complications of surgery are minimal and involve:

  • Bleeding
  • Infection

It should be kept in mind that there are chances of failure to achieve union and re-fracture even after surgery. Return to normal activity should only be considered when radiological signs of healing are achieved as this is the main factor predictive of treatment failure.

 

Jones fractures usually take a longer time to heal due to relative lack of blood supply. 

 

Surgery is the only choice in cases of non-union or chronic Jones fractures. Immobilization and no weight bearing are the essential parts of treatment. Irrespective of the mode of treatment, normal activities can only be resumed after radiological signs of healing. You may have to wait longer if the signs of healing are not seen, so if you want to know about your healing progress, talk to your doctor. 

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