Diagnose on Sight: Fifth Metatarsal Fractures
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?
[su_spoiler title=”Answer” style=”fancy” icon=”caret”]
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.
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
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
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
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