Finally, the sural nerve is very close to the entry point for intramedullary screw fixation and should be identified and protected during reconstructive procedures ( 12). Most importantly, there is a watershed area at the metaphysis–diaphysis junction between the proximal metaphyseal blood supply and the diaphyseal part of the bone supplied by the nutrient artery which is greatly responsible for the highest risk of delayed union/non-union of these fractures ( 10, 11) ( Fig. Additionally, two sesamoid bones, the os peroneum (inside the peroneus longus tendon) and os vesalianum (just proximal to the fifth metatarsal base), should be differentiated from fractures, having a smooth contour ( 9). It is these features that account for the increased propensity of delayed union/non-union in the metaphyseal–diaphyseal junction, and additionally, the stresses exerted at the mobile metatarsal head, which are directed to the base, using the metaphyseal–diaphyseal junction as a fulcrum ( 8). In addition, the proximal part of the fifth metatarsal is relatively fixed by strong ligaments attaching to the cuboid and other metatarsals, whereas its shaft remains mobile. Four structures attach on the fifth metatarsal base, dorsally peroneus brevis attaches at the tubercle, peroneus tertius at the metaphyseal–diaphyseal junction, and abductor digiti minimi and the lateral band of the plantar fascia on the plantar-lateral aspect ( 8) ( Fig. Several specific anatomical considerations are crucial in assessing the healing potential and therefore the management of these injuries.
#Cpt orif 5th metatarsal fracture update#
The purpose of the herein study is to provide an update in regard to the evaluation, management, and outcomes of these important and frequent injuries. Nowadays, the term ‘Jones fracture’ defines just one type of the fifth metatarsal fracture, that is a ‘Zone 2’ injury, and there are several misconceptions and controversies regarding the terminology and treatment of these injuries. Sir Robert Jones was the first who described the metaphyseal–diaphyseal (within 0.75 inches from the base) fifth metatarsal fracture in four patients in Liverpool in 1902, with himself sustaining the same injury while dancing ( 7). Besides football, other sports with an increased risk of suffering these fractures include soccer, basketball, and track and field athletes ( 4, 6). In elite athletes ( 4), a 5-year review from a single National Football League (NFL) team demonstrated an incidence of 3.42% ( 5). Noteworthy, the majority of young patients are males, whereas older patients are females ( 3). person-years, with patients most frequently presenting between 20 and 50 years of age ( 2). Their incidence has been reported as high as 1. Metatarsal fractures represent the most common injury of the foot, accounting for approximately 5–6% of all the fractures encountered in the primary care setting, with about 45–70% of these injuries involving the fifth metatarsal ( 1).
Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems.Ĭommon surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature.
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