Jones fracture

The Jones fracture is a complex fracture of the fifth metatarsal bone, which affects the proximal meta-diaphyseal junction and is mainly observed in competitive athletes and soldiers. The fracture can occur in the form of a fatigue fracture or an acute fracture. Therapy is either a plaster cast or an operation.

What is a Jones fracture?

There are different fractures of the metatarsal bone. One of them is the Jones fracture. This is a fracture close to the base that affects the proximal meta-diaphyseal junction in the fifth metatarsal and usually does not involve the tarsometatarsal joint. As a rule, however, the intermetatarsal joint to the metatarsal portion of the fourth metatarsal is affected.

The Jones fracture has a lower prevalence than avulsion fractures of the tuberosity, which are also present with involvement of the joints. With a Jones fracture there is usually a high risk of pseudarthrosis if the fracture does not heal sufficiently. The namesake of the Jones Fraktur is Sir Robert Jones, who suffered the Fraktur at a dance event in the early 20th century and then described it extensively.

Different types of fracture exist. Basically, most fractures in the fifth metatarsal are called Jones' fractures or Pseudojones fracture although they do not have all of the manifestations relevant to this fracture.

causes

Fifth metatarsal fractures are usually caused by excessive stress. If the cause corresponds to an overload, they are called a fatigue fracture or a stress fracture. Complex foot malpositions can also cause such fatigue fractures in the metatarsal area. Patients with conditions such as osteoporosis are particularly susceptible to such fractures.

The Jones fracture at the base of the fifth metatarsal bone usually results from an overload on the outer edge of the foot. In most cases, the fracture is preceded by an outward twisting. As a result, the tendon on the short fibula muscle often tears out at the base and facilitates the break at the base of the metatarsal bone.

The Jones fracture is located in the area of ​​the metatarsus with the least blood supply and has little potential for self-healing because of the poor blood circulation. In addition to young soldiers, athletes often have to struggle with Jones fractures, for which the risk of twisting and overloading is part of everyday life.

Symptoms, ailments & signs

If the Jones fracture occurs as a stress fracture, there are few symptoms at the beginning. The symptoms increase progressively over the course of the day. On the other hand, if the Jones fracture occurs as an acute fracture, the bone breaks suddenly and symptoms appear immediately without taking on a progressive form. One of the most important symptoms after a Jones fracture is moderate to severe pain on the outer edge of the affected foot.

The foot usually swells and is sensitive to any contact. When straining, the pain becomes unbearable, so that severe and pain-related movement restrictions and relieving postures often occur. The Jones fracture affects an extremely limited area of ​​the fifth metatarsal.

Due to the narrowness of the area, there is little blood flow in this area, so that in most cases there are no bruises because the bone fracture does not injure any vessels. If the fracture damages nerves, discomfort or numbness may develop in the affected area. A Jones fracture takes an extremely long time to heal because of the poor blood flow. Over time, the fracture can lead to pseudarthrosis.

Diagnosis & course of disease

X-ray imaging is used to diagnose a Jones fracture. The fracture runs at the metadiaphyseal junction of the metatarsal bone over to the shaft axis and lies about two centimeters distal to the tarsometatarsal joint. However, the x-ray clearly shows that the joint is not involved. Displaced fractures, in most cases, are not Jones fractures.

In young patients, the doctor must distinguish the Jones fracture from the normal apophyseal plate between the ages of 9 and 14 years. The prognosis for patients with a Jones fracture is not particularly favorable. In many patients, for example, conventional therapies do not heal the fracture or only heal it after a delay, thus causing secondary symptoms.

Complications

As a rule, the Jones fracture is very painful and there are still restrictions in movement. As a result, the patients can also suffer from psychological complaints or depression. It is not uncommon for paralyzes and disorders of sensitivity to occur.

The patients suffer from bruises and severe restrictions in everyday life. It is possible that the exercise of the profession or various sporting activities is restricted or no longer completely possible. The Jones fracture can be treated with a cast and pain medication. As a rule, there are no particular complications.

Life expectancy is not limited or reduced by the Jones fracture. If there is any consequential damage, a surgical intervention may be necessary. Furthermore, the person affected is often dependent on regular examinations. Even after the treatment, there may be restrictions in everyday life or movement. In some cases the patient is then dependent on the help of other people or on a walking aid. Psychological complaints can be treated by a psychologist.

When should you go to the doctor?

A doctor's visit is necessary as soon as pain develops in the metatarsal area. In particular, complaints on the outer edge of the foot indicate a Jones fracture and must be examined by a doctor. A doctor should be consulted if there is impairment after a heavy load on the foot or a fall.

If the foot cannot be placed on the ground free of symptoms and loaded with its own weight while moving, a doctor should be consulted to clarify the cause. In the case of swelling, discoloration of the skin or a reduction in the usual exposure limit, there is a health irregularity that must be examined and treated.

If the person concerned feels tightness while wearing the usual shoes or if the shoes no longer fit, a doctor should be consulted. A doctor is needed in the event of mobility restrictions, sensory disorders of the skin or problems with blood circulation. In some cases the symptoms appear insidious and there is no triggering event.

A visit to the doctor is still necessary and should take place as soon as you notice the first symptoms. If the pain worsens or spreads in the foot, consultation is required before taking any pain reliever medication. Consultation with a doctor is urgently recommended to avoid side effects or sequelae.

Therapy & Treatment

The blood supply is critical in the Jones fracture. Therefore, healing is often severely delayed, despite therapy options. The first step in conventional therapy is a plaster of Paris treatment for the fracture. The plaster of paris on the metatarsal bone severely restricts the patient and usually causes them many problems in everyday life. Those affected are usually given mild pain relievers for their pain.

The osseous development of the hernia usually takes about ten weeks. The ten-week immobilization in plaster is associated with severe impairment of mobility, which is hardly an option for competitive athletes, for example. If particularly rapid restoration of all mobility is required, conventional therapy is not used in most cases.

The treatment in these cases usually corresponds to an osteosynthesis. Various techniques are available for this operative connection of two or more bones or fragments. For example, intramedullary screw osteosynthesis or tension belts using a K-wire are often used for Jones fractures. The mini-plate osteosynthesis is also a suitable therapy for patients with the Jones fracture.

Although the bone usually grows together faster with these surgical procedures than with conventional therapy, the therapies do not rule out subsequent symptoms or areas that break open again. Therefore, regular checks are often carried out long after the operation.

Outlook & forecast

Recovery from surgery involves not only recovery from the surgery itself, but most importantly, time to allow the metatarsal fracture to heal. This usually takes 6-8 weeks, which is longer than many other fractures.

In contrast to avulsion fractures, Jones fractures are prone to pseudarthrosis. Pseudarthroses refer to bone fractures that have not healed, which are always diagnosed when there is no healing between two x-rays. This is usually the case after 6-8 months. Internal fixation and bone grafting may be necessary if there is pseudarthrosis or if the delay in the fracture is significantly delayed.

Since the Jones fracture is in the area of ​​the metatarsal with the poorest blood flow, there is little chance of self-healing. If the fracture is left untreated, there is a high likelihood of pseudarthrosis. In the worst case, the fracture point will grow together incorrectly. This often leads to malpositions, which can be very painful when stressed and which require surgical correction.

prevention

The Jones fracture can be prevented. One of the most important preventive measures is, for example, avoiding overloading the metatarsal bones. Just as important is the avoidance of foot misalignments and the strengthening of the ligaments in the metatarsal area.

Aftercare

In most cases, the patient with a Jones fracture does not have special or direct follow-up care options. The person concerned must first and foremost see a doctor at the first symptoms and signs of the disease so that there are no further complications or other complaints. The earlier a doctor is contacted, the better the further course of this disease is usually.

Usually, the Jones fracture does not reduce the life expectancy of the person affected and it can be completely cured in the process. The treatment is primarily carried out by immobilizing the affected foot. The person concerned should rest after the accident and under no circumstances should they exert themselves. Physical or stressful activities should be avoided in any case, in order not to worsen the symptoms further.

Likewise, most patients with the Jones fracture in most cases need the help and support of family and friends, who can make everyday life easier. In some cases, physiotherapy measures are also necessary, although some exercises can also be performed in your own home.

You can do that yourself

If you have a Jones fracture, the most important self-help measure is to take care of the affected foot until the fracture has completely healed. The affected person should not exert himself excessively for at least three to four weeks and, above all, should not strain the affected foot. Exercise and physically demanding work should be strictly avoided. The doctor will also recommend comprehensive wound care to the patient to avoid inflammation and other secondary symptoms.

Drug pain therapy can be supported by some means from nature. For example, ointments and teas made from willow bark, turmeric or peppermint are effective. In addition, meditation is recommended, preferably under the guidance of a professional. From the field of naturopathy, for example, the remedies belladonna and arnica are recommended. Preparations with these active ingredients relieve the pain and reduce any inflammation in the area of ​​the injury. However, the use of alternative remedies should first be discussed with the doctor.

If the Jones fracture is still painful after a few weeks, a doctor is recommended. The affected foot must be spared until healing is complete.