Case: A 24 year old male presents with foot pain after a fall down a set of stairs. He reports pain and swelling over the lateral surface of his foot and he has not ambulated due to the pain. Based on the X-ray, what is the diagnosis?
Poll Results
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Pseudo-Jones fracture
Explanation
Fractures of the fifth metatarsal are the most common of all foot fractures.1 Emergency physicians must understand the different types of fractures as management and prognosis differs widely.
Figure credit: F. Gaillard. Radiopaedia.org, 2009
The inter-metatarsal joint between the bases of the fourth and fifth metatarsals is a key landmark (identified by black X in image above) for classifying proximal fifth metatarsal fractures. Tuberosity (styloid) fractures occur proximal to this joint while fractures of the metaphyseal-diaphyseal junction (Jones fractures) extend toward this joint.2
Figure credit: Radiopedia.org, Dr. Amir Rezaee and Dr Abhijit Datir et al.
The patient in this case has a proximal tuberosity avulsion fracture, also known as Pseudo-Jones fracture. The fracture here extends into the cubo-metatarsal joint and is clearly proximal to the inter-metatarsal joint. Treatment of a Pseudo-Jones fracture involves symptomatic care and weight bearing as tolerated with most fractures healing in three to six weeks.2
Figure credit: Radiopedia.org, Dr. Amir Rezaee and Dr Abhijit Datir et al.
This is a Jones’ Fracture. In 1902, Sir Robert Jones first described a specific fifth metatarsal fracture at ‘the proximal 3/4 segment of the shaft distal to the styloid by indirect violence of his own foot and that of four other patients.’ The Jones’ fracture has since been defined as:1
A transverse fracture at the metaphyseal/diaphyseal junction without distal extension beyond the fourth to fifth intermetatarsal articulation.
The Jones fracture is specially recognized by emergency physicians because it:3
- Has high likelihood of delayed union or non-union
- Often requires surgical intervention
- Requires orthopedics consultation
Master Clinician Bedside Pearls
Tim Horeczko, MD, MSCR, FACEP, FAAP
Assistant Professor, Department of Emergency Medicine, Harbor-UCLA Medical Center
Founding Director, Research Associates in the Department of Emergency Medicine (RAD-EM)
Host and Coach, Pediatric Emergency Playbook | pemplaybook.org
Twitter: @EMtogether
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