Fifth metatarsal fractures: an update on management, complications, and outcomes

Abstract

• 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 theterm ‘Jones’ fracture has been used inconsistently in the literature.• In the vast majority of patients, Zone 1 fractures are treated non-operatively with goodoutcomes.• Treatment of Zone 2 and 3 fractures remains controversial and should be individualizedaccording to the patient’s needs and the ‘personality’ of the fracture.• 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 fixationwith specifically designed plating systems.• Common surgical complications include hardware failure or irritation of the soft tissues,refracture, non-union, sural nerve injury, and chronic pain.• Patients should be informed of the different treatment options and be part of the decisionprocess, especially where time for recovery and returning to previous activities is of essence,such as in the case of high-performance, elite athletes