Jones fracture is a complex fracture of the fifth metatarsal involving the proximal meta-diaphyseal junction, most commonly seen in competitive athletes or soldiers. The fracture can occur inform a fatigue fracture or an acute fracture. Therapy involves either casting or surgery.
What is a Jones fracture?
There are several fractures of the metatarsal. One of them is the Jones fracture. This is a fracture close to the base that involves the proximal meta-diaphyseal junction in the fifth metatarsal and is usually without involvement of the tarsometatarsal joint. However, the intermetatarsal joint to the metatarsal portion of the fourth metatarsal is usually involved. Jones fracture has a lower prevalence than avulsion fractures of the tuberosity, which also present with joint involvement. In most cases, Jones fracture has a high risk of pseudarthrosis if the fracture does not heal adequately. The eponym of the Jones fracture is Sir Robert Jones, who suffered the fracture at a dance event in the early 20th century and subsequently described it extensively. Different types of the fracture exist. Generally, most fractures in the fifth metatarsal are referred to as Jones fractures or pseudo-Jones fractures, although they do not all have the manifestations relevant to this fracture.
Causes
Fractures of the fifth metatarsal are usually caused by excessive weight bearing. When the cause corresponds to overload, they are called fatigue fractures or stress fractures. Complex foot deformities can also cause such fatigue fractures in the metatarsal region. Patients with conditions such as osteoporosis are particularly susceptible to such fractures. The Jones fracture at the base of the fifth metatarsal is usually caused by overloading on the outer edge of the foot. In most cases, the fracture is preceded by twisting outward. As a result, the tendon on the short fibula muscle often avulses bony at the base, promoting the fracture at the base metatarsal. In this case, the Jones fracture is located in the least perfused part of the midfoot and has little potential for self-healing because of poor circulation. In addition to young soldiers, athletes often struggle with Jones fractures, for whom the risk of twisting and overuse is part of everyday life.
Symptoms, complaints and signs
When the Jones fracture occurs as a fatigue fracture, there are few symptoms at first. However, the symptoms increase progressively as it progresses. In contrast, if the Jones fracture occurs as an acute fracture, the bone breaks suddenly and symptoms occur immediately without taking a progressive form. The main symptoms following a Jones fracture include moderate to severe pain at the outer edge of the affected foot. The foot usually swells and is sensitive to any touch. When weight is placed on it, the pain becomes unbearable, often resulting in severe and painful restriction of motion and relieving postures. The Jones fracture affects an enormously limited area of the fifth metatarsal. Due to the narrowness of this area, there is little blood supply, so in most cases there is no bruising because the fracture does not injure any vessels. If the fracture damages nerves, the affected area may experience discomfort or numbness. To heal, a Jones fracture takes an extraordinary amount of time because of the poor blood supply. Over time, the fracture can promote pseudarthrosis.
Diagnosis and disease progression
Radiographic imaging is used to diagnose a Jones fracture. The fracture extends across the metadiaphyseal junction of the metatarsal to the shaft axis and is located approximately two centimeters distal to the tarsometatarsal joint. However, the radiograph clearly shows that there is no involvement of the joint. Displaced fractures are not Jones fractures in most cases. In young patients, physicians must differentiate Jones fractures from normal apophyseal fractures between the ages of 9 and 14 years. The prognosis for patients with a Jones fracture is not particularly favorable. In many patients, for example, conventional therapies fail to heal the fracture or delay its healing, allowing secondary symptoms to develop.
Complications
As a rule, Jones fracture results in severe pain and further in limitations in movement. As a result, patients may also suffer from psychological discomfort or depression. It is not uncommon for bade to also experience paralysis and sensory disturbances. Patients suffer from bruising and severe restrictions in everyday life. It is also possible that the exercise of the profession or various sporting activities is limited or no longer fully possible. The Jones fracture can be treated with a cast and by taking painkillers. This does not usually result in any particular complications. Life expectancy is also not limited or reduced by the Jones fracture. If consequential damage has occurred, surgical intervention may be necessary. Furthermore, the affected person is not infrequently dependent on regular examinations. Even after treatment, there may be restrictions in everyday life or movement. In some cases, the patient is then dependent on the help of other people or on a walking aid. Psychological complaints can be treated by a psychologist.
When should you see a doctor?
A visit to the doctor is necessary as soon as pain develops in the area of the midfoot. In particular, discomfort at the outer edge of the foot indicates a Jones fracture and should be evaluated by a doctor. If there is any impairment following a heavy load on the foot or a fall, a doctor should be consulted. If the foot cannot be placed on the ground without discomfort and loaded with its own weight during locomotion, a physician should be consulted to determine the cause. If there is swelling, discoloration of the skin, or a reduction in the usual weight-bearing limit, there is a health irregularity that needs to be investigated and treated. If the affected person feels tightness when wearing the usual footwear or if the shoes no longer fit, a doctor should be consulted. If there are restrictions in mobility, sensory disturbances on the skin or problems with blood circulation, a doctor is needed. In some cases, the symptoms develop gradually and there is no triggering event. A visit to the doctor is nevertheless necessary and should take place as soon as the first symptoms are noticed. If the pain increases or spreads to the foot, consultation is necessary before taking painkilling medication. Consultation with a medical professional is strongly advised to avoid side effects or sequelae.
Treatment and therapy
Blood supply is critical in Jones fracture. Therefore, despite treatment options, healing is often severely delayed. The first step in conventional therapy is to apply a cast to the fracture. The cast on the metatarsal severely restricts the patients and usually causes them many problems in everyday life. Patients are usually given mild painkillers to relieve their pain. The fracture usually takes about ten weeks to heal. The ten-week period of immobilization in a cast is associated with severe restrictions on mobility, which is hardly an option for competitive athletes, for example. If a particularly rapid restoration of all mobility is required, conventional therapy is not used in most cases. In these cases, treatment usually corresponds to osteosynthesis. Various techniques are available for this surgical connection of two or more bones or fragments. For example, intramedullary screw osteosynthesis or tension taping using K-wire are often applied in Jones fracture. Miniplate osteosynthesis is also a suitable therapeutic approach for Jones fracture patients. Although the bone usually grows together more quickly with these surgical procedures than with conventional therapy, the therapies do not rule out secondary problems or re-rupture. Therefore, regular checkups often take place long after surgery.
Outlook and prognosis
Recovery after surgery includes not only recovery from the surgery itself, but more importantly the time to allow the metatarsal fracture to heal. Usually this includes a period of 6-8 weeks, which is longer than many other fractures. Unlike avulsion fractures, Jones fractures are prone to pseudarthrosis.Pseudarthrosis refers to unhealed bone fractures, which are always diagnosed when there is no healing between two X-rays. This is usually the case after 6-8 months. Internal fixation and bone grafting may be necessary in cases of pseudarthrosis or when there is a significant delay in fracture healing. Because the Jones fracture is located in the area of the metatarsal that has the poorest blood supply, there is little chance for self-healing. If the fracture is not treated, pseudarthrosis will most likely result. In the worst case, false fusion of the fracture site must be expected. This often results in malalignment, which can be very painful with weight-bearing and may result in surgical correction.
Prevention
The Jones fracture can be prevented. For example, the most important preventive measures include avoiding overloading the metatarsals. Equally important is avoiding foot malalignment and strengthening the ligamentous system around the midfoot.
Aftercare
In most cases, there are no specific or direct aftercare options available to the patient with a Jones fracture. In this case, the affected person must primarily seek medical attention at the first symptoms and signs of the condition to prevent further complications or other medical conditions from developing. The earlier a doctor is contacted, the better is usually the further course with this disease. As a rule, the Jones fracture does not reduce the life expectancy of the affected person and can also be completely cured. Treatment is primarily by immobilization of the affected foot. The affected person should rest after the accident and in no case exert himself. Physical or stressful activities should be avoided in any case, so as not to further aggravate the symptoms. Likewise, in most cases of Jones fracture, patients are dependent on the help and support of family and friends, which can facilitate everyday life. In some cases, physical therapy measures are also necessary, although some exercises can be performed in the patient’s own home.
What you can do yourself
In the case of a Jones fracture, the most important self-help measure is to rest the affected foot until the fracture is completely healed. The affected person should avoid excessive exertion for at least three to four weeks and, most importantly, should not put any weight on the affected foot. Sports activities and physically strenuous work should be strictly avoided. The physician will also recommend comprehensive wound care to the patient to avoid inflammation and other subsequent complaints. Medicinal pain therapy can be supported by some natural remedies. For example, ointments and teas made from willow bark, turmeric or peppermint are effective. Meditation is recommended as a supplement, preferably under the guidance of a specialist. From the field of naturopathy, for example, the remedies belladonna and arnica are recommended. Preparations with these active ingredients relieve pain and inhibit any inflammation in the area of the injury. However, the use of alternative remedies should first be discussed with the doctor. If the Jones fracture is still causing pain after a few weeks, a visit to the doctor is recommended. The affected foot must be rested until healing is complete.
