Percutaneous Fixation of Proximal Fifth Metatarsal Fractures

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.