![]() perhaps up to 2/3 of these fractures should heal w/ a frx that is minimally displaced, is < 3 months old, and radiographs show frx w/o evidence of non-union (i.e., intra-medullary sclerosis andĪ lucent fracture line), non-operative treatment can be recommended non operative treatment should be reserved only for acute frxs (in most cases) Non Operative Treatment: (Acute Jones Frx) frx lines tend to be oriented more transversely to the joint orientation of apophyseal line is parallel to shaft of metatarsal and it does not extend proximally into joint frx configuration in young adolescents: stress frx is revealed by a widened frx line and varying degrees of meduallary sclerosis delayed union will show persistent frx line in both cortices, periosteal callus (use hot lamp), and intra-medullary sclerosis acute fractures should show sharp frx margins and no intramedullary sclerosis in addition to fracture location (which distinguishes avulsion from Jones frx), it is important to note characteristic features at the frx site radiographs show non-union and medullary sclerosis or even obliteration of the medullary canal if several months have passed since the onset of symptoms, established non-union may already be present. usually, there has been gradual onset of pain on outer side of foot, & only when pain interferes w/ walking does pt seek treatment may present as acute lesion or may be seen in chronic phase, and either presentation has prolonged healing course, compared w/ frxs of other metatarsals consider bone-grafting & internal fixation w/ compression screw if non union has developed, with widening of frx line & sclerosis, cast mobilization is unlikely to be successful with closed treatment the rate of non union is 50% w/ stress frx (indictating a chronic frx), an atheletic pt may benefit from ORIF these may be symptomatic before radiographic evidence of frx these occur distal to the ligaments which firmly bind the 4th and 5th metatarsals together ossicle in peroneus longus tendon where it is seen at the tip of the fifth metatarsal base it does not extend proximally into the joint (unlike the fracture) apophyseal line runs parallel to shaft of metatarsal along its lateral-inferior margin of the tubercle usually present between the ages of 9 to 14 years this is the most common frx of the base of the 5th metatarsal hence, strictly speaking a Jones frx is an acute injury in addition, the acute Jones frx must be distinguished from the chronic Jones frx the later of which may represent a stress frx w/ poor prognosis for healing this fracture is usually proximal to the metatarsal cuboid joint Jones frx is located w/in 1.5 cm distal to tuberosity of 5th metatarsal & should not be confused w/ more common avulsion frx of 5 th metatarsal styloid involves frx at base of fifth metatarsal at metaphyseal-diaphyseal junction, which typically extends into the 4-5 intermetatarsal facet
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