Case: A 24 year old male presents with foot pain after a fall down a set of stairs. He reports pain and swelling over the lateral surface of his foot and he has not ambulated due to the pain. Based on the X-ray, what is the diagnosis?

Poll Results

Pseudo-Jones fracture

Explanation

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Fractures of the fifth metatarsal are the most common of all foot fractures.1 Emergency physicians must understand the different types of fractures as management and prognosis differs widely.

The inter-metatarsal joint between the bases of the fourth and fifth metatarsals is a key landmark (identified by black X in image above) for classifying proximal fifth metatarsal fractures. Tuberosity (styloid) fractures occur proximal to this joint while fractures of the metaphyseal-diaphyseal junction (Jones fractures) extend toward this joint.2

The patient in this case has a proximal tuberosity avulsion fracture, also known as Pseudo-Jones fracture. The fracture here extends into the cubo-metatarsal joint and is clearly proximal to the inter-metatarsal joint. Treatment of a Pseudo-Jones fracture involves symptomatic care and weight bearing as tolerated with most fractures healing in three to six weeks.2

This is a Jones’ Fracture. In 1902, Sir Robert Jones first described a specific fifth metatarsal fracture at ‘the proximal 3/4 segment of the shaft distal to the styloid by indirect violence of his own foot and that of four other patients.’ The Jones’ fracture has since been defined as:1

A transverse fracture at the metaphyseal/diaphyseal junction without distal extension beyond the fourth to fifth intermetatarsal articulation.

The Jones fracture is specially recognized by emergency physicians because it:3

Has high likelihood of delayed union or non-union

Often requires surgical intervention

Requires orthopedics consultation

Master Clinician Bedside Pearls

Tim Horeczko, MD, MSCR, FACEP, FAAP

Assistant Professor, Department of Emergency Medicine, Harbor-UCLA Medical Center

Founding Director, Research Associates in the Department of Emergency Medicine (RAD-EM)

Host and Coach, Pediatric Emergency Playbook | pemplaybook.org

Twitter: @EMtogether

1. Injury. 2010;41(6):555-562. PubMed] Zwitser E, Breederveld R. Fractures of the fifth metatarsal; diagnosis and treatment.. 2010;41(6):555-562. 2. Am Fam Physician. 2007;76(6):817-826. PubMed] Hatch R, Alsobrook J, Clugston J. Diagnosis and management of metatarsal fractures.. 2007;76(6):817-826. 3. Clin Sports Med. 2006;25(1):139-50, x. PubMed] Fetzer G, Wright R. Metatarsal shaft fractures and fractures of the proximal fifth metatarsal.. 2006;25(1):139-50, x.

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