Treatment of Jones Fractures
Jones fractures should be treated based on fracture characteristics, with surgical fixation recommended for displaced fractures (>2mm), high-performance athletes, or fractures with delayed union, while non-displaced fractures in non-athletes can be effectively managed with non-weight bearing immobilization for 4-6 weeks.
Understanding Jones Fractures
Jones fractures are transverse fractures occurring at the proximal fifth metatarsal at the metaphyseal-diaphyseal junction (zones 2 or 3), distinct from avulsion fractures (zone 1) that occur more proximally 1. These fractures occur in a vascular watershed region, which contributes to their higher risk of delayed union or nonunion.
Assessment and Classification
- Confirm diagnosis with appropriate radiographs in multiple views
- Assess displacement (>2mm is considered significant)
- Evaluate for any associated injuries
- Classify the fracture:
- Zone 1: Avulsion fracture (not a true Jones fracture)
- Zone 2: Acute Jones fracture at the metaphyseal-diaphyseal junction
- Zone 3: Stress fracture in the proximal diaphysis (also considered a Jones fracture)
Treatment Algorithm
Non-Surgical Management
Indicated for:
- Non-displaced or minimally displaced fractures (<2mm)
- Low-demand, non-athletic patients
- Patients who prefer conservative management
Protocol:
- Non-weight bearing cast immobilization for 4-6 weeks 2
- Followed by weight-bearing boot for additional 2-4 weeks
- Gradual return to activities after clinical and radiographic healing
Recent evidence suggests that weight-bearing as tolerated in a walking boot may be a viable alternative for certain patients, with similar outcomes to non-weight bearing protocols 3. This approach showed a 6.4% nonunion rate compared to 37.5% in the non-weight bearing group in one study, though this finding requires further validation.
Surgical Management
Indicated for:
- Displaced fractures (>2mm)
- High-performance athletes
- Delayed union or nonunion after conservative treatment
- Zone 3 fractures (diaphyseal stress fractures)
Surgical options:
- Intramedullary screw fixation (most common)
- Bicortical screw fixation
- Open reduction and internal fixation for complex cases
In elite athletes, surgical treatment is strongly preferred, with 77% of NFL team physicians recommending surgical management over non-surgical treatment (23%) 4. Intramedullary screw fixation has shown a 94% union rate in professional athletes.
Expected Outcomes and Complications
Conservative Treatment
- Healing rates: 80-90% in appropriate candidates 2, 5
- Time to radiologic union: Typically 8-12 weeks
- Return to sports/activities: 10-14 weeks
- Complications: 10.8% complication rate 2, with risk of delayed union or nonunion requiring subsequent surgery
Surgical Treatment
- Healing rates: 89-94% 2, 4
- Time to radiologic union: 6-8 weeks
- Return to sports/activities: 8-10 weeks
- Complications: 13% complication rate 2, including hardware irritation, infection, or refracture
Follow-up Protocol
- Clinical and radiographic follow-up at 2-week intervals initially
- Assess for:
- Pain levels
- Fracture healing on radiographs
- Return of function
- Continue follow-up until radiographic union is evident and patient returns to pre-injury function
Special Considerations
- Athletes: Consider early surgical intervention to facilitate faster return to play and reduce nonunion risk
- Non-athletes: Conservative management is often appropriate if the fracture is non-displaced
- Chronic fractures with sclerosis: Higher failure rate with conservative management (up to 50%) 5, consider primary surgical intervention
Rehabilitation
- Begin gentle range of motion exercises after immobilization period
- Progress to strengthening exercises after fracture healing is evident
- Gradual return to activities based on clinical and radiographic healing
The treatment choice should be guided by fracture characteristics, patient activity level, and expectations for return to function, with surgical management generally providing faster healing and return to activities but carrying surgical risks.