Jones fractures are complex injuries with highly variable treatment paradigms. This study aims to establish an expert consensus with support from a systematic review to guide management of Jones fractures in elite athletes. A consensus process was conducted using a modified Delphi technique with two rounds of questionnaires. Consensus was defined as 75%-85% agreement, strong consensus as 86%-99% agreement, and unanimous consensus as 100% agreement. In addition, a systematic review was conducted to evaluate nonoperative versus operative management of Jones fractures in athletes. Of 37 total consensus statements, 15 achieved unanimous consensus, 21 achieved strong consensus, and 1 reached consensus. The systematic review included 27 studies consisting of 1056 patients. The majority of fractures with a stress aetiology were treated with open reduction internal fixation (86.4%), with a mean return to sport time of 13.3 ± 4.5 weeks and a complication rate of 8.4%. Treatment failure was highest for stress fractures that were treated nonoperatively (8.2%). Traumatic Jones fractures were treated surgically in 62.7% of cases, with the remaining 37.3% managed conservatively. All patients with traumatic fractures successfully returned to sport at an average of 11.6 ± 2.2 weeks regardless of treatment modality. Treatment failure following traumatic fractures was highest for those treated conservatively (16.1%). The average time to return to sport following Jones fracture was shorter among athletes who were treated surgically compared to those who were treated nonoperatively, regardless of injury aetiology or degree of chronicity. This consensus process reached unanimous agreement with respect to the use of MRI for nondisplaced fractures, the use of CT for comminuted or displaced fractures, indications for minimally invasive techniques, and use of adjunctive bone grafting. Level V.

The Reduction of Bowing of the Fifth Metatarsal after Intramedullary Screw Insertion for Jones fractures may Reduce Risk of Refracture.

Biomechanical evaluation of fixation methods used in the treatment of fifth metatarsal fractures and the development of a novel biodegradable screw design.

Background: Management of fractures of the base of 5th metatarsal has long been a topic of debate, particularly regarding the effectiveness of operative and non-operative treatment approaches. This study aimed to evaluate the outcomes of internal fixation using an intramedullary screw in management of Jones fracture. Methods: Twenty-one patients diagnosed with Jones fracture were surgically fixed with intramedullary screw and were evaluated on the basis of union time and the American Orthopaedic Foot and Ankle Society score at 6 weeks and 12 weeks. Results: Overall union time of the study patients was 6.76 weeks (SD=0.768). There was a non-significant relationship between age and union time (r=0.146, p=0.528) in the patients. The overall mean AOFAS score at 6 weeks increased from 87.43±5.005 to overall mean score 94.09±2.364 at 12 weeks after treatment. There was a significant negative correlation between age and AOFAS at 6-weeks (r=-0.673, p<0.001) and at 12-weeks (r=-0.542, p=0.011) post treatment. Conclusions: The treatment with surgical screw fixation is safe and effective method for treatment of acute Jones fracture and can be strongly recommended in those who want to return to normal activity earlier.

Background: Jones fractures of the 5th metatarsal are frequently associated with nonunion due to limited vascularization and repetitive mechanical stress. The aim of the study was to compare the biomechanical performance of T-plate and bicortical screw fixation using standardized 3D models. Methods: Three-dimensional models of the 5th metatarsal were generated from CT images and printed using PolyJet technology (Stratasys J5 DentaJet) using a rigid-elastic composite with properties similar to cortical and cancellous bone. Jones fractures were fixed with either a locked T-plate or a bicortical screw. The samples were tested under axial and oblique static loads (α = 0°, 90°, 180°) and for three values of interfragmentary distance (d = 0.1–1 mm), in a 3 × 2 factorial design. Results: The T-plate fixation recorded a maximum yield force (Fmax) of 149.78 ± 8.53 N (138–161 N), significantly higher compared to the bicortical screw −98.56 ± 2.58 N (96–101 N), (p < 0.05). The ductility index was higher for the plate, indicating a progressive transition to yield. The α and d factors significantly influenced the mechanical behavior, with the polynomial model explaining over 95% of the total variation. Discussion: The plate fixation demonstrated greater strength and superior biomechanical tolerance in imperfect reduction scenarios. The main limitation is the lack of fatigue testing and the inability of 3D models to reproduce the structural heterogeneity of human bone. Conclusions: Implant selection should be individualized based on fracture stability. 3D models provide a reproducible platform for comparative evaluation of osteosynthesis methods, but future studies should include cyclic loading and biological validation.

Research Type:Level 4 – Case seriesIntroduction/Purpose:Given the latest advancements in artificial intelligence, platforms such as Chat Generative Pre-trained Transformer (ChatGPT) have gained popularity among the public seeking health advice. Since May 2024, ChatGPT has garnered over 180.5 million monthly users. There is a paucity of literature examining the accuracy of ChatGPT in foot and ankle surgery, particularly for fractures at the metadiaphysis of the 5th metatarsal (Jones fractures). It is advantageous to examine the efficacy of patient education tools regarding these fractures, which occur at an incidence of approximately 6.7 per 10,000 people. The present study aims to investigate the quality of responses generated by ChatGPT in answering common questions about the diagnosis and treatment of Jones fractures.Methods:Nine frequently asked questions regarding Jones fractures were posed to ChatGPT 3.5 and 4o. Data was collected on June 28, 2024 in one sitting, as the platform is continuously evolving. Two senior authors scored the responses as either “excellent response not requiring clarification,” “satisfactory requiring minimal clarification,” “satisfactory requiring moderate clarification,” or “unsatisfactory requiring substantial clarification,” corresponding to scores of 1, 2, 3, and 4, respectively. Flesch Reading Ease score and Flesch-Kincaid Grade Level (corresponding to US grade level) were used to assess length and readability of the AI-generated answers.Results:The mean rating for ChatGPT 3.5 responses was 2.89 ± 0.78 compared to 1.78 ± 0.83 for ChatGPT 4o (p=0.0133), with lower scores corresponding to better quality responses. In cases of disagreement, a consensus was reached between the graders. Flesch Reading Ease was an average of 43.7 and 49.06 for ChatGPT 3.5 and 4o, respectively (p= 0.0918) which both correlate with a college reading level. Flesch-Kincaid Grade Level was an average of 11.19 and 9.27 for ChatGPT 3.5 and 4o, respectively (p=0.0214).Conclusion:ChatGPT 4o scored better in accuracy compared to ChatGPT 3.5. Flesch Reading Ease and Flesch-Kincaid Grade Level both improved with the development of ChatGPT 4o, but need improvement given that the average American reads at the 8th grade level. To our knowledge, this is the first study within foot and ankle surgery that compares different versions of ChatGPT, with previous studies either not specifying or featuring an older chatbot version such as 3.0. Users should always consult a surgeon and recognize ChatGPT’s shortcomings, including a lack of citations and inherent biases.

Several types of fifth metatarsal (MT) fractures exist and are treated with various methods of immobilization, weight bearing restrictions, and occasionally operative procedures. This study evaluated the differences in clinical and radiographic outcomes among pseudo-Jones fractures (Zones 1 and 2), true Jones fractures (Zone 3), and fifth metatarsal shaft and neck fractures. A retrospective review of a consecutive series of patients presenting to a single academic medical center with a fifth metatarsal fracture between 2012 and 2022 was conducted. Radiographs obtained at the initial presentation were reviewed, and fracture patterns were categorized as either Zone 1, Zone 2, Zone 3, shaft, neck, or head fractures. In total, 1314 patients with isolated fifth metatarsal fractures were treated (mean age = 49.6 ± 18.0 years). In total, 1217 fractures (92.5%) were initially treated nonoperatively, and 97 fractures (7.5%) were treated operatively. The overall time to clinical and radiographic healing for all fifth metatarsal fractures treated nonoperatively was 9.9 ± 8.7 weeks and 17.9 ± 15.6 weeks, respectively (P = .245, P = .088). Immediate weightbearing led to a faster time to clinical healing by (P = .035). There was no statistically significant difference in time to clinical or radiographic union among the different fracture types (P = .496, P = .400). Likewise, there was no evidence of any difference in time to clinical or radiographic union for patients treated operatively versus nonoperatively (P > .05). This study demonstrates all closed isolated fifth metatarsal fractures can be successfully treated nonoperatively with immediate weightbearing and similar times to clinical and radiographic healing.Levels of Evidence: III.

BackgroundJones fractures are fifth metatarsal stress fractures frequently seen in athletes and often lead to delayed union, non-union, and refracture. Identifying risk factors for Jones fractures is essential for prevention. While two-dimensional (2D) imaging has provided insights, it cannot adequately assess three-dimensional (3D) bone morphology. Statistical shape modeling (SSM) enables comprehensive 3D evaluation of anatomical variations, although its role in Jones fractures remains unclear. This study aimed to identify 3D morphological factors associated with Jones fractures using SSM and assess postoperative morphological changes.MethodsIn this retrospective comparative study, we analyzed 20 patients with Jones fractures and 20 matched controls. All patients underwent headless compression screw fixation. Computed tomography was used to create 3D models of the fifth metatarsal. Segmentation and alignment were performed, followed by SSM with ShapeWorks. Principal component analysis (PCA) identified shape variations. Statistical comparisons were made between preoperative fracture cases and controls and between preoperative and postoperative cases.ResultsSSM identified six significant PCA modes, accounting for 78.3% of shape variation. The second mode showed significant differences between fracture patients and controls (p = 1.32e-04), demonstrating greater adduction of the metatarsal base, reduced articular surface, proximally extended tuberosity, and straighter, thicker shaft in fracture cases. No significant postoperative morphological changes were observed.ConclusionDistinct 3D morphological characteristics of the fifth metatarsal–including base adduction, proximal tuberosity extension, and shaft straightening–may increase susceptibility to Jones fractures. The absence of postoperative changes suggests that surgical fixation does not alter these features.

Hip internal rotation restriction and heel raise mechanics as risk factors for Jones fractures in youth football players

Rate of bony union after Jones fracture fixation in the general population.

Highlights • This article aims to present a rare fracture combination of ankle and foot fractures and dislocations. Which will allow professionals a rapid recognition and adequate management of this type of trauma. • It also presents the peculiarities of radiological diagnosis. • Our work talks about the specificity of the management of this trauma. Keywords: Jones fracture, Talar neck fracture-dislocation, Ankle fracture, Medial Malleolus fracture, Tibial pilob fracture, Ankle strain, McReynolds approach, Hawkins Classification, Lauge Hensen classification, case report, SCARE criteria.

Jones fracture of the fifth metatarsal is a common overuse injury in soccer players and may cause long-term absence from training. Despite the increasing population of female soccer players, the incidence and risk factors of Jones fracture, including plantar pressure characteristics, among these players have not been clarified. To investigate the association between Jones fracture and plantar pressure distribution during running and musculoskeletal characteristics in young female soccer players. Case-control study; Level of evidence, 3. A cohort of female soccer players who played competitively in high school and college teams, aged 15 to 21 years, were followed over a year. All players underwent physical examination at baseline, which included anthropometric measurements, body composition evaluation, joint laxity, double- and single-leg balance measurements, lower limb muscle flexibility, and hip internal rotation angle, foot arch height ratio, and dynamic foot pressure measurements during running. Foot pressure distribution was analyzed by measuring the sum and maximal pressure of 10 areas, and the loading rates of the lateral toes, lateral metatarsal, lateral forefoot, forefoot/rearfoot ratio, and lateral/medial ratio were defined. All these measurements were compared between players who had Jones fracture (Jones group) and players without injuries (control [Con] group). A total of 105 players were included, and 4 players (6 feet) were included in the Jones group. Hamstring flexibility was significantly lower in the Jones group than in the Con group. The Jones group presented a higher forefoot/rearfoot ratio of the maximal pressures, lower sum pressure in the lateral heel, higher maximal pressure in the lateral toes, and higher maximal pressure in the first to third metatarsals than the Con group. No significant differences were found between the 2 groups regarding other factors. Foot plantar pressure with a higher forefoot/rearfoot ratio, less loading on the heel, and higher pressure on the lateral toes and medial metatarsals during running were associated with Jones fracture in female soccer players. Lower hamstring flexibility was identified as a risk factor for Jones fracture, which has not been reported in male soccer players.

IntroductionFifth metatarsal fractures have been regularly classified by zones, with the description of a Jones fracture commonly being misrepresented. The aim of this study was to map the fracture patterns across the entire metatarsal shaft, and correlate with their outcomes.MethodsA historic cohort study was completed of all fifth metatarsal fractures presenting to our unit between February 2016 – July 2021. Fracture patterns were individually mapped and designated as zone 1-shaft, including designation of fractures which bridge each zone (zone 1–2 etc). Fracture patterns were cumulatively combined using GNU Image Manipulation Program to show the combined fracture map patterns per outcome. The clinical notes were examined to assess patient outcome.Results1331 fractures were included in this study and presented graphically as fracture maps by outcome. The number of fractures which did not propagate across more than 1 zone was 78.59% (1046/1331). The fracture type which had the highest rate of discharge at VFC without reattendance was Zone 1 fractures (360/519, 69.36%), with the lowest being fractures where the fracture spanned zone 1-shaft (p&lt;0.001).The total number of fractures that underwent surgery was 1.35% (18/1331). The fracture pattern which had the highest rate of surgical intervention was a fracture that spanned zone 2–3 (5/43, 11.63%) followed by a fracture that spanned zone 1–3 (1/11, 9.9%).The number of appointments given to patients ranged from discharged from VFC to 7 face to face appointments. The patients with the lowest discharge rate prior to 4 appointments was zone 2–3.ConclusionsIn our series, almost a quarter of fractures spanned across the previously described fracture zones. This would explain the low inter-observer rating in previous studies. The classic Jones fracture would span zones 2/3, which in our series had the highest rate requiring surgery and lowest rate of discharge before 4 appointments.

Submission Type: Base of the Fifth Metatarsal Fractures Research Type: Level 4 – Case series Introduction/Purpose: Metatarsus adductus is the most prevalent congenital foot disorder and results in soft tissue contractures and foot remodeling. Metatarsus adducutus can regress into numerous pathologies including hallux valgus, skew foot, and recurrent fifth metatarsal fractures. Fifth metatarsal fractures can also result from cavovarus foot deformity. There is no known literature directly comparing the percentage of fifth metatarsal fracture patients with either cavovarus foot deformity or metatarsus adductus. We hypothesize that having an elevated metatarsal adductus angle (MAA) of over 15 degrees predisposes patients to proximal fifth metatarsal fractures more than neutral or cavovarus deformity. Methods: Patients with fifth metatarsal fractures were assessed for the age, sex, fracture side, and fracture type. Fractures were radiographically classified as zone 1 (pseudo-Jones), zone 2 (Jones), or zone 3 (stress fracture). MAA and lateral Meary’s angle (LMA) of the affect foot measured radiographically. These measurements were used to quantitively compare the degree of metatarsus adductus and cavus deformity with the fracture type. Results: A total of 17 patients (4 men, 13 women) were identified with a mean age of 41. The patients who sustained a stress fracture had a mean MAA of 29.2 degrees (20.9 to 36.9) and LMA of 10.5 degrees of planus (-28.8 to +3). The Jones fracture group had a mean MAA of 19.7 degrees (19.1 to 20.7) and LMA of 1.1 degrees of cavus (-3.9 to 3.7). The pseudo-Jones group had a mean MAA 16.8 degrees (9.9 to 19.8) and LMA of 0.1 degrees of planus (-8.4 to 7.5). Conclusion: In conclusion, there is a high MAA in patients with fifth metatarsal Jones, pseudo-Jones, and stress fractures. The patient group with the highest MAA was the stress fracture group. Of note, patients with fractures do not necessarily have cavus deformity, but rather our results show that many patients have neutral to planus arches. There may be a role of custom shoe inserts to prevent future problems in patients with metatarsus adducts in the setting of bilateral pathology or recurrent fractures.

In professional basketball, Jones fractures are among the most common cause of lower extremity stress injury. Despite its prevalence, there is a paucity of research on the impact of Jones fractures on athletic performance in the National Basketball Association (NBA). To determine the impact of Jones fractures on return to play and performance among NBA players when compared with preinjury values and healthy matched controls. Cohort study; Level of evidence, 3. NBA injury reports were analyzed to identify 18 players who sustained a Jones fracture between 2011 and 2022. Reports were verified through public press releases, social media accounts, and player profiles. A publicly available database was used to collect player data including position, age, and years of NBA experience. Performance and advanced statistics were collected for seasons pre- and postinjury. Players were 1:1 matched with healthy controls based on age, player position, and career performance. Univariate and multivariable regression analyses were performed to compare advanced and per-game performance statistics between injured and healthy control players. NBA players who sustained a Jones fracture had a mean age of 23.9 ± 2.31 years at the time of injury. The mean NBA experience was 3.00 ± 2.35 years and mean preinjury minutes played per game was 19.64 ± 11.24. All players (18/18) were able to return to NBA-level competition the year following the injury. There was no change in player efficiency rating (PER), value added, and estimated wins added metrics when comparing pre- and postinjury performances among injured players. Injured players missed more games (P < .001) postinjury compared with the matched controls. Multivariate analysis revealed that for players with a height of <2 m, every additional centimeter of height significantly decreased postinjury PER by 1.08 (95% CI, 0.35-1.80; P < .01). Despite its severity, most NBA players who sustain Jones fractures can return to preinjury performance and level of competition. There was no statistically significant decline in advanced statistics in the following season after injury, with a significant decrease in games played when comparing injured players with their healthy controls.

The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires. A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according to the fixation techniques. A vertical load, oriented from plantar to dorsal and lateral to medial, was applied to the metatarsal specimen that were potted with molding material. The stiffness and fatigue values were compared between the three fixation groups. In the plantar to dorsal load test, the stiffness values were found to be significantly higher in Group 1 compared to the other groups (P = .034, P = .013). No significant difference was found in the analysis in terms of fatigue values in plantar to dorsal load testing (P = .348, P = .416). No significant difference was found between compression screw and tension band groups in lateral to medial loading test, in terms of stiffness and fatigue values (P = .096, P = .762). However, the stiffness values and fatigue values of these two groups were found to be statistically significantly higher than the Kirschner wire group (P = .003, P = .002, P = .016, P = .023). The result of this study showed that the bicortical fixation of headless compression screw provides a more stable fixation than other fixation methods, especially in plantar to dorsal loading.

Screw Fixation versus Casting in the Treatment of Acute Jones Fracture

This study presents the rehabilitation process for the management of six cases of fractures of the fifth metatarsal bone in players of various sports playing at high levels of competition in Poland. The course of treatment was based on an intensive rehabilitation protocol with the need for orthopaedic shoe inserts, with full weight bearing on the limb and under close supervision of a physiotherapist. The effectiveness of rehabilitation was assessed by physical examination, X-ray examination and the numerical pain rating scale - NRS. This study focuses on the rehabilitation process for managing fractures of the fifth metatarsal bone in high-level athletes in Poland. The treatment involved an intensive rehabilitation protocol with orthopaedic shoe inserts, full weight bearing, and physiotherapist supervision. The effectiveness of rehabilitation was evaluated through physical exams, X-rays, and the numerical pain rating scale. Introduction Fractures of the fifth metatarsal bone are common in athletes aged 10-29, especially in football, basketball, and dance. Complications include delayed bone fusion and repeat fractures, emphasizing the importance of quick return to fitness. The involvement of physiotherapists and patient positivity is crucial. The debate among clinicians stems from classification variations and interpretations of 'Jones fractures'. Diagnostic and Classification Methods The Lawrence and Bottle classification distinguishes three types of metatarsal fractures: avulsion, Jones, and fatigue fractures. The study presents six cases of conservative treatment for these fractures, showing positive outcomes in returning athletes to competition. Rehabilitation Procedure Patients underwent functional treatment with orthopaedic insoles, immediate weight-bearing, and various therapies like Orthokine®, Exogen, hyperbaric chamber sessions, ESWT, and EPTA. Post-workout treatments included Game Ready®, flossing, manual therapy, dry needling, and lymphatic drainage. Patients also engaged in self-managed rehabilitation exercises. Treatment Results Radiographic examinations showed progressive healing in all cases, with reduced pain and no edema after two weeks. Patients returned to sports within three weeks, with no complaints after 13 months. The study highlights the success of functional treatment in achieving full recovery without complications. Conclusion The study challenges the need for surgical intervention and immobilization in treating fifth metatarsal fractures. Functional treatment led to excellent outcomes and quick return to sports. Literature review supports early mobilization and functional therapy for optimal results. Further research is needed to establish a standard treatment protocol based on evidence-based medicine.

Introduction: Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various intramedullary screw fixation constructs. Methods: Jones fracture model over the proximal 5th metatarsal of artificial bone was created in all specimens. Six groups were divided based on varied screw constructs with different screw lengths, either 30 or 40mm, including cannulated screws-C30 and C40 groups, one high-resistance suture combined with intramedullary cannulated screws (F.E.R.I. technique)-CF30 and CF40 groups, and second-generation headless compression screws (SG-HCS) -HL30 and HL40 groups. Mechanical testing was conducted sequentially, and the maximal force (N) and stiffness (N/mm) of all constructs were recorded. Results: The maximal force (N) at 1.0mm downward displacement in C30, C40, CF30, CF40, HL30, and HL40 groups were 0.56 ± 0.02, 0.49 ± 0.02, 0.65 ± 0.02, 0.49 ± 0.01, 0.68 ± 0.02, and 0.73 ± 0.02, respectively, and the stiffness (N/mm) in subgroups were 0.49 ± 0.01, 0.43 ± 0.01, 0.67 ± 0.01, 0.42 ± 0.01, 0.61 ± 0.01, and 0.58 ± 0.02, respectively. SG-HCS subgroups exhibited greater maximal force and stiffness than conventional cannulated screws. Screws of 30mm in length demonstrated better stability than all 40mm-length screws in each subgroup. In C30 fixation, the stiffness and maximum force endured increased by 1.16 and 1.12 times, respectively, compared with the C40 fixation method. There were no significant differences between CF30 and SG-HCS groups. Only the F.E.R.I technique combined with the 4.5mm cannulated screw of 30mm in length increased the biomechanical stability for Jones fractures. Discussion: These biomechanical findings help clinicians decide on better screw fixation options for greater stability in Jones fractures, especially when large-diameter screws are limited in use. However, this biomechanical testing of intramedullary screw fixation on Jones fracture model lacks clinical validation and no comparisons to extramedullary plate fixations. Moving forward, additional clinical and biomechanical research is necessary to validate our findings.

Significant heterogeneity in the classification and treatment of zone 3 proximal fifth metatarsal base fractures ("true Jones fractures") exists. This study compared time to clinical and radiographic healing between patients treated operatively and nonoperatively. We hypothesized that patients treated nonoperatively may demonstrate a greater time to clinical healing. This was a retrospective cohort study of patients presenting to a large, urban, academic medical center with "Jones" fractures between December 2012 and April 2022. Jones fractures were defined as fifth metatarsal base fractures occurring in the proximal metadiaphyseal region, distal to the articulation of the fourth and fifth metatarsals on the oblique radiographic view. Clinical healing was the time point at which the patient had returned to their baseline ambulatory status with no tenderness to palpation. Radiographic healing was the presence of bridging callus across at least 3 cortices. A total of 2450 patients presented with fifth metatarsal fractures, and 166 fractures (6.8%) were true Jones fractures. Among patients with Jones fractures, 120 patients with 121 Jones fractures followed up at our institution and were included in the analysis (mean age 46.5 ± 18.5 years). Ninety-nine fractures (81.8%) were treated nonoperatively and 22 fractures (18.2%) operatively. There were no differences between nonoperative and operative groups in time to clinical healing (12.7 ± 7.1 vs 12.8 ± 4.8 weeks, P = .931) or radiographic healing (13.2 ± 8.1 vs 11.7 ± 5.9 weeks, P = .331). Overall healing rate was 96% for the nonoperative group compared with 96.2% for the operative group. In this study, nonoperative and operative treatment of true Jones fractures were associated with equivalent clinical and radiographic healing. The rate of delayed union in true Jones fractures was lower than previously described, and there was no difference in delayed union rate between nonoperative and operative management. Level III, retrospective cohort study.