Posts for: January, 2014
Fifteen years ago while I was visiting my parents in Wales, my mother slipped and fell down a few stairs twisting her foot. She was in a terrific amount of pain so we took her to Casualty (ER). They x-rayed her foot and diagnosed her with a Jones fracture. This rather well known fracture was first described Sir Robert Jones (a fellow Welshman) who sustained this injury himself while dancing in 1902. He wrote a paper in the Annals of Surgery that same year describing the fracture in himself and 5 other individuals. Initially he thought he may have torn his Peroneus Longus tendon (a tendon on the outside of the foot) but he felt the tendon and found it to be intact. Although x-rays were relatively new at that time he suspected bone involvement and asked his colleague Dr. David Morgan to take radiographs of his foot. Examination of the radiographs revealed a fracture, 3/4 of an inch distal to the fifth metatarsal base (at the metaphyseal-diaphyseal junction). He was surprised that this fracture did not occur due to direct trauma but rather a cross-strain applied to the bone. The mechanism of injury was forced inversion (twisting in) of the foot when the ankle is tilted down (plantar flexed) and the weight is on the outside ball of the foot. These fractures are known to be relatively poor healers due to diminished blood supply at the metaphyseal-diaphyseal junction of the fifth metatarsal.
Conservative care for a non-displaced acute Jones fracture usually involves non-weightbearing in a cast for 6-8 weeks; however, many doctors recommend surgical repair of this fracture in more active individuals, athletes, or in cases where the fracture is chronic in nature. Surgical repair will often increase the healing rate and decrease the risk of re-injury. Surgical techniques vary. Often a small incision is used to place a guide wire in the bone followed by a cannulated screw down the intramedullary canal of the fifth metatarsal bone.
Sometimes for chronic fracture non-unions (where a fracture has failed to heal over a period greater than 6 months) a metallic plate may be used with or without a bone graft.