Jone's fracture by Dr.Mahbub

Published by Dr.Sk Golam Mahbub

1. WELCOME Short Notes Presentation

2. JONES FRACTURE Dr. Sheikh Golam Mahbub D(Ortho)Student Orthopaedics Surgery BSMMU

3. What is Jones Fracture ? The Jones fracture is defined as a fracture 1.5 cm distal to the tuberosity of the 5 th meta tarsal base in which the main fracture line extend in to the 4 th -5 th metatarsal articulations.

4. Why it is called jones fracture ? First described in 1902 by orthopedic surgeon Sir Robert Jones. He sustained the injury himself(while dancing) as a f racture of the 5 th metatarsal about three-fourths of a n inch from its base.

5. Anatomy The peroneus brevis tendon and lateral band of the plantar fascia insert onto the base of the fifth metatarsal . There is a relative watershed in the blood supply to the 5 th metaTarsal at the junction between the diaphysis and metaphysis.

6. Continue … Proximally, affecting the tuberosity, in the region of articulation with the fourth metatarsal, or at the metaphyseal/ diaphyseal junction. Higher rate of non-union, probably as a consequence of the relatively poor blood supply in that region .

7. Mechanism Of Injury The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion

8. Clinical Presentation P ain over this middle/outside area of foot Swelling Difficulty Walking

9. Radiological Findings Diagnostic x-rays include anteroposterior, oblique, and lateral views and should be made with the foot in full flexion. X-Ray shows a transverse fracture near the metatarsal base , usually small fragment & Minimally displaced. Should not be confused with normal  apophysis of the proximal 5 th   metatarsal .

10. Classification of fracture (According to site )

11. Classification of Fracture of 5 th Metatarsal Type Description I Acute fractures at the metaphyseal- diaphyseal junction. IA Nondisplaced IB Displaced or comminuted or both. II Fractures at the metaphseal-diaphyseal junction with clinical or radiographic evidence of previous injury (i.e., pain, sclerosis ). III Fractures of the styloid process of the fifth metatarsal. IIIA Without involvement of the fifth metatarsocuboid joint. IIIB With involvement of the fifth metatarsocuboid joint.

12. Differntial Diagnosis Avulsion Fracture Os Peroneum Diaphyseal Stress Fractures

13. Treatment Non Surgical Until you are able to see a foot & ankle surgeon. the “ R.I.C.E ” method of care should be performed REST : Stay off the injured foot ICE : Apply an icepack to the injured area COMPRESSION : An elastic wrap should be used to control swelling ELEVATION : The foot should be raised above the level of Heart to reduce swelling If a jones fractures is not significantly displaced, it can be treated with a cast,splint or walking boot for 4 to 8 weeks.

14. When is Surgery Needed Zone 1   treated without surgery cast , boot or hard-soled shoe heal within six to eight weeks. Zone 2 higher chance of nonunion risk of refracture even after healing. Surgical treatment is common. Zone 3   typically stress fractures in athletes risk of refracture may be reasons for surgical repair in these fractures.

15. Type l Fractures T ype IA fracture (acute) Non–weight bearing, Short leg cast is worn for 6 to 8 weeks followed by a weight bearing cast until union has been achieved Type IB fractures with displacement and comminuted In competitive athletes, consideration should be given to early open reduction and internal fixation to decrease disability time. use of electrical and pulsed ultrasound and bone stimulation for may improve healing of the fracture. Surgery should be considered for type I fractures that are not healing clinically at 8 to 12 weeks

16. Type ll Fractures Type II fractures (partial or complete canal obliteration and sclerosis) Non–weight bearing casting may yield satisfactory results. Immobilization and non–weight bearing is approximately 8 weeks. Refracture is common in this category Surgery should be considered for type II fractures in competitive athletes and others whose occupational demands do not allow prolonged non–weight bearing immobilization

17. Type lll Fractures Type III fractures S hort leg cast for 3 weeks followed by a well-molded arch support. Nonunions of type III fractures may occur, they rarely are painful and can be treated with excision of the fragment

18. Surgical Treatment Fixation with a medullary 4.5-mm malleolar screw Corticocancellous in lay bone grafting with clearing of the medullary canal of all sclerotic bone 5.5-mm and larger cannulated screws, and non cannulated screws with low-profile heads.  Fractures of the shaft of the metatarsal are typically fixed with a plate and screws

19. Surgical Approach Incision through skin only 1 fingerbreadth proximal to base of 5 th MT Parallel to peroneals Supine position Flex knee and place foot on base

20. Post operative care A well-padded, short-leg, non-walking cast, extending to the toes, is applied. Non weight bearing for 2 weeks. Weight bearing in a cast may be started 2 weeks postoperatively . Ankle ROM against gravity abduction/adduction, planter and dorsiflexion. Return to competitive sports is usually takes 10 to 12 weeks.

21. Complications Refracture Screw Failure Non union Infection Sural nerve injury Hardware discomfort

22. Conclusions The Jones fracture presents a dilemma in treatment of the active patient. Jones fracture has a high rate of nonunion due to low vascular integrity. Though cast treatment has been shown to be effective, early screw fixation of the Jones fracture will results in shorter times to union & return to activity. Operatively treated Jones fracture have a high success rate. Athlete should not be allowed to return to full activity until full radiographic union is evidenced. Even with non–weight bearing immobilization for 6 to 8 weeks, type I fractures have a reported nonunion rate of 7% to 28%.