Open Reduction and Internal Fixation of Proximal Fifth Metatarsal (Jones or Stress) Fracture

Fracture in zone II or III of the proximal fifth metatarsal (5MT; Fig. 24.1 )

Acute fracture in an athlete

Delayed union

Nonoperative treatment with casting, protected weight bearing

Intramedullary screw fixation

External bone stimulation

Tension band technique/plating

Tenderness at the base of the 5MT

Hindfoot alignment

Radiographs demonstrating fracture in zone II of the 5MT

• Fracture in the base of the 5MT extending into articulation of fourth MT and 5MT bases on anteroposterior ( Fig. 24.2A ), oblique ( Fig. 24.2B ), and lateral ( Fig. 24.2C ) views

  

There is a watershed area of relatively less perfusion in zone II of the 5MT base ( Fig. 24.3A ).

The 5MT is a curved bone (relevant to fixation with a straight implant [screw]; Fig. 24.3B ).

At-risk structures include the peroneus brevis and longus and the sural nerve ( Fig. 24.3C ).