What is your management in the emergency department?

Jones fractures are typically managed non-operatively. They should be placed in a short leg splint and made non-weight bearing for at least 6 weeks [1].

Patients with Zone I fractures can remain weight-bearing as tolerated with a hard-soled shoe or walking boot [3]. Zone III fractures should be managed similarly to Zone II, although these may take up to 20 weeks to heal [1].

• Pearl: If there is uncertainty about the zone, err on the conservative side by initially placing a short-leg splint until they can receive follow-up.

What complications may arise?

Delayed union or non-union and refracture are common complications for all fifth metatarsal fractures. Zone I has been shown to have a much lower rate of non-union (~1%) when compared to Zone II and Zone III (~25%) [2].

• Pearl: Jones fractures are particularly at risk for delayed union or non-union because the metaphysis-diaphysis junction is a watershed area [2].

What is your disposition?

After splint placement, the patient can be discharged home and instructed to follow-up with an orthopedic surgeon or primary care sports medicine physician.

• Pearl: While Zone I fractures rarely require surgical intervention, surgical management for Zone II and Zone II fractures may be considered for athletes, patients who decline conservative treatment, or those who wish to return to activity earlier [3]. Displaced Zone II fractures may also require operative intervention [1].

What is another associated injury that needs to be considered?

When evaluating fifth metatarsal fractures, it is also important to confirm there is not an associated Lisfranc injury (where the metatarsal base is displaced from the tarsus) because a Lisfranc injury requires early operative management, and delay or failure to treat may lead to post-traumatic arthritis [2].