This 2000 narrative review by Rosenberg and Sferra addresses the persistent clinical confusion surrounding proximal fifth metatarsal fractures by systematically examining the three distinct injury patterns — tuberosity avulsion, acute Jones fracture, and diaphyseal stress fracture — and defining the evidence base for treatment of each, including management of delayed unions and nonunions.
When you see a fracture at the base of the fifth metatarsal, resist calling it a 'Jones fracture' until you confirm it crosses the fourth-fifth intermetatarsal facet with no prodromal symptoms — misclassification drives inappropriate treatment and distorts prognosis.
In athletes with a true acute Jones fracture, counsel early that nonoperative management carries up to a 28% nonunion rate and a time-to-union approaching 21 weeks, making primary intramedullary screw fixation a defensible first-line choice.
This 2000 narrative review by Rosenberg and Sferra addresses the persistent clinical confusion surrounding proximal fifth metatarsal fractures by systematically examining the three distinct injury patterns — tuberosity avulsion, acute Jones fracture, and diaphyseal stress fracture — and defining the evidence base for treatment of each, including management of delayed unions and nonunions.
When you see a fracture at the base of the fifth metatarsal, resist calling it a 'Jones fracture' until you confirm it crosses the fourth-fifth intermetatarsal facet with no prodromal symptoms — misclassification drives inappropriate treatment and distorts prognosis.
In athletes with a true acute Jones fracture, counsel early that nonoperative management carries up to a 28% nonunion rate and a time-to-union approaching 21 weeks, making primary intramedullary screw fixation a defensible first-line choice.