Tuberosity avulsion fractures are proximal fifth metatarsal styloid fractures resulting from a forceful pull of the lateral band of the long plantar ligament or the peroneus brevis tendon during ankle inversion. A 12-week RCT in 89 consecutive patients presenting to an emergency department with fifth metatarsal tuberosity avulsion fractures compared a nonrigid, soft Jones’ dressing consisting of alternating layers of cast padding and elastic bandages with a rigid short leg casting.8 The Jones’ dressing had a significant 28% reduction in time to return to pre-injury levels of activity. Other outcomes—time in treatment modality, time to radiographic healing, and functional foot score—were not different between intervention groups. Validity was limited by the 32% lost to follow-up rate.
FIGURE
Acute fracture of the fifth metatarsal
Acute Jones’ fractures are repaired with screw fixation of the broken bone using fluoroscopy. Patients may return to full activity when radiographs show that the bones were healing at the site of the fracture.
Recommendations from others
We were unable to locate any consensus statements or clinical guidelines regarding the treatment of Jones’ fractures.
DeLee and Drez’s Orthopaedic Sports Medicine recommends immobilization in a cast or below-the-knee boot with strict non-weightbearing for at least 6 weeks for acute Jones’ fractures.9 It recommends surgical treatment, followed by 6 weeks of cast immobilization, then progression to weight bearing based on radiographic findings, for nonoperative treatment failures or with desire to return high-performance athletes to activity.
In Fracture Management for Primary Care, the authors recommend posterior splinting and non-weightbearing with crutches for acute Jones’ fractures, followed by non-weightbearing short leg casting application at 3 to 5 days from injury.10 After a minimum of 6 to 8 weeks of casting, they recommend options of 4 additional weeks of casting or internal fixation for clinical or radiographic nonunion.
For tuberosity avulsion fractures, the authors recommend use of a firm-soled shoe for 4 to 8 weeks. For patients with discomfort at an initial 4- to 7-day follow-up, they give an option of using a walking short leg casting for 2 weeks, with follow-up every 2 to 4 weeks until clinical healing.