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Percutaneous Fixation of Proximal Fifth Metatarsal Fractures

  • Jonathan R. Saluta
  • James A. Nunley
Chapter

Abstract

Fractures of the proximal fifth metatarsal can be divided into three general patterns: avulsion of the tuberosity (type 1), Jones fractures (type 2), and diaphyseal stress fractures (type 3).1 Tuberosity fractures can be extraarticular or may involve the metatarsocuboid joint (Fig. 62.1). Jones fractures involve the metaphyseal-diaphyseal junction and extend transversely and medially into the 4–5 intermetatarsal joint (Figs. 62.1 and 62.2). Unlike tuberosity fractures, which reliably heal, Jones fractures have a nonunion rate between 7 and 28%.2,3 In addition, one third of Jones fractures treated conservatively may go on to closed refracture.4 Diaphyseal stress fractures occur distal to the 4–5 intermetatarsal joint (Fig. 62.1) and are usually associated with prodromal symptoms. Torg5 divides diaphyseal stress fractures into three types: acute fractures with sharp margins, delayed unions with a widened fracture line and intra-medullary sclerosis, and established nonunions with complete obliteration of the canal.

Keywords

Sural Nerve Canal Diameter Intramedullary Canal Shaft Screw Operating Room Table 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Quill G Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am 1995;26:353–361PubMedGoogle Scholar
  2. 2.
    Torg J, Balduini F, Zelko R, Pavlov H, Peff T, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity: classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am 1984;66:209–214PubMedGoogle Scholar
  3. 3.
    Clapper M, O’Brien T, Lyons P. Fractures of the fifth metatarsal: anal-ysis of a fracture registry. Clin Orthop Relat Res 1995;315:238–241PubMedGoogle Scholar
  4. 4.
    Quill G Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am 1995;26:353–361PubMedGoogle Scholar
  5. 5.
    Torg J, Balduini F, Zelko R, Pavlov H, Peff T, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity: classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am 1984;66:209–214PubMedGoogle Scholar
  6. 6.
    Mall N, Queen R, Glisson R, Nunley JS. Patterns and risk factors of screw failure in intramedullary fixation of fifth metatarsal Jones fractures: a biomechanical study. Unpublished data, 2006Google Scholar
  7. 7.
    Horst F, Gilbert B, Glisson R, Nunley J. Torque resistance after fixation of Jones fractures with intramedullary screws. Foot Ankle Int 2004;25(12):914–919PubMedGoogle Scholar
  8. 8.
    Nunley J. Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am 2001;32(1): 171–180CrossRefPubMedGoogle Scholar
  9. 9.
    Johnson J, Labib S, Fowler, R. Intramedullary screw fixation of the fifth metatarsal: an anatomic study and improved technique. Foot Ankle Int 2004;25(4):274–277PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Surgery, Division of Orthopaedic SurgeryDuke University Medical CenterDurhamUSA

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