What is the recommended treatment for a Jones fracture?

Treatment of Jones Fracture

Primary Treatment Recommendation

Both conservative and surgical treatment are effective for Jones fractures, but surgical fixation with intramedullary screw achieves faster radiographic union and earlier return to sports, while conservative treatment with non-weightbearing cast immobilization for 4-6 weeks yields excellent functional outcomes with acceptable union rates and should be considered first-line for most patients. 1

Conservative Management Approach

Initial conservative treatment consists of non-weightbearing cast immobilization for 4-6 weeks, followed by weight-bearing boot immobilization before return to activity. 1

• Clinical union occurs at a mean of 8.0 weeks with conservative treatment without weightbearing restriction, achieving 89% union rate. 2
• Conservative treatment demonstrates favorable outcomes in time to return to sports and pain scores at 2 weeks compared to surgical intervention. 1
• The complication rate with conservative management is 10.8%, which is comparable to surgical treatment at 13%. 1
• Patients can be treated without strict weightbearing restriction, resulting in rapid clinical union with only 4% nonunion rate. 2

Common pitfall: Inadequate immobilization duration leads to delayed union or nonunion. Ensure full 4-6 weeks of non-weightbearing followed by protected weightbearing. 1

Surgical Indications and Technique

Surgical fixation is indicated for:

• Professional athletes or highly active patients requiring rapid return to sports 1, 3
• Delayed healing or refracture after initial conservative treatment 4
• Established nonunion with radiographic evidence of stress fracture 4
• Patients prioritizing faster radiographic healing over avoiding surgery 1

Surgical technique involves intramedullary screw fixation (solid screw or Herbert screw) with bicortical purchase. 1, 3

• Surgical treatment achieves radiographic union at mean 5.7 weeks, significantly faster than conservative treatment. 5
• Herbert screw fixation demonstrates AOFAS scores of 97-100 in 86% of patients at 6 weeks, compared to only 33% exceeding 90 points with conservative treatment. 3
• Radiographic healing at 6 weeks occurs in 47% of surgical patients versus 0% of conservative patients. 3

Postoperative Protocol

Early weightbearing protocol after surgical fixation:

• Immediate weightbearing in controlled ankle motion boot for 2 weeks 5
• Transition to regular shoes at 2 weeks postoperatively 5
• Low-impact activities (walking, swimming, biking, elliptical) permitted at 2 weeks 5
• Return to all activities as tolerated at 6 weeks, regardless of radiographic healing 5

This aggressive protocol achieves 100% union rate at mean 5.7 weeks with only 6.5% hardware removal rate. 5

Complications and Management

Surgical complications include:

• Sural neuritis (3.2%) requiring hardware removal 5
• Wound dehiscence and K-wire migration (rare) 4

Conservative treatment failure:

• If AOFAS score remains below 80 at 6 weeks or no radiographic healing progress, offer surgical conversion. 3
• Nonunion requiring surgery involves decortication, wide resection, excochleation of fibrous tissue, and autologous cortico-cancellous bone grafting with tension wire loop fixation. 4
• Surgical salvage of nonunion achieves clinical healing in 3-6 months (average 4 months). 4

Decision Algorithm

For acute Jones fractures:

1. Non-athletes or recreational athletes: Start with 4-6 weeks non-weightbearing cast, then protected weightbearing boot 1
2. Professional athletes or highly active patients: Offer immediate surgical fixation with intramedullary screw 1, 3
3. Risk-averse patients prioritizing avoiding surgery: Conservative treatment is appropriate with 89% success rate 1, 2
4. Patients at 6 weeks with AOFAS <80 or no healing: Convert to surgical fixation 3

Critical point: Both treatment modalities achieve excellent final AOFAS scores with no significant difference at final follow-up, making patient preference and activity level the primary determinants. 1