Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 6, pp 1307–1315 | Cite as

Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review

  • Andrew J. RocheEmail author
  • James D. F. Calder



The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed to establish what the outcomes were for different treatments modalities. By doing this, the clinician will be better prepared to institute a logical, evidence-based approach to the treatment of their patients with this injury.


A thorough literature search was performed from 1980 to present day. Studies were included based on set criteria and analysed for their validity, and their results were scrutinised. Jones fractures were segregated into acute fractures, delayed unions and non-unions.


Twenty-six studies were included, of which 22 were level 4 evidence, with only 1 randomised controlled trial. Functional outcome data were limited to return to sports in most studies with few studies using established scoring systems. Return to sports following intra-medullary screw fixation for acute fractures ranged from 4 to 18 weeks. Acute fractures treated non-operatively had a union rate of 76 % (pooled), whereas in fractures treated with a screw it was 96 % (pooled). Delayed unions treated non-operatively had a union rate of 44 and 97 % treated operatively. Non-unions treated with screw fixation healed in 97 % of cases.


Although supported by mostly level 4 evidence, intra-medullary screw fixation is more likely to lead to successful union of all types of Jones fractures compared to non-operative treatments. Early return to play in athletes prior to full radiological union is not advised in case of re-fracture.

Level of evidence



5th Metatarsal Jones fracture Sport Treatment 


  1. 1.
    Alvarez RG, Cincere B, Channappa C et al (2011) Extracorporeal shock wave treatment of non-or delayed union of proximal metatarsal fractures. Foot Ankle Int 32:746–754PubMedCrossRefGoogle Scholar
  2. 2.
    Critical Appraisal Skills Programme. Solution for public health. Available via Accessed 1 Jan 2012
  3. 3.
    Dameron TB (1975) Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am 57:788–792PubMedGoogle Scholar
  4. 4.
    Delee JC, Evans JP, Julian J (1983) Stress fracture of the fifth metatarsal. Am J Sports Med 11:349–353PubMedCrossRefGoogle Scholar
  5. 5.
    Fernández Fairen M, Guillen J, Busto JM et al (1999) Fractures of the fifth metatarsal in basketball players. Knee Surg Sports Traumatol Arthrosc 7:373–377PubMedCrossRefGoogle Scholar
  6. 6.
    Fetzer GB, Wright RW (2006) Metatarsal shaft fractures and fractures of the proximal fifth metatarsal. Clin Sports Med 25:139–150PubMedCrossRefGoogle Scholar
  7. 7.
    Furia JP, Juliano PJ, Wade AM et al (2010) Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am 92:846–854PubMedCrossRefGoogle Scholar
  8. 8.
    Glasgow MT, Naranja RJ, Glasgow SG et al (1996) Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture. Foot Ankle Int 17:449–457PubMedCrossRefGoogle Scholar
  9. 9.
    Hunt KJ, Anderson RB (2011) Treatment of Jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting. Am J Sports Med 39:1948–1954PubMedCrossRefGoogle Scholar
  10. 10.
    Jones R (1902) I. Fracture of the base of the fifth metatarsal bone by indirect violence. Ann Surg 35:697–702PubMedGoogle Scholar
  11. 11.
    Kavanaugh JH, Brower TD, Mann RV (1978) The Jones fracture revisited. J Bone Joint Surg Am 60:776–782PubMedGoogle Scholar
  12. 12.
    Kerkhoffs GM, Versteegh VE, Sierevelt IN et al (2012) Treatment of proximal metatarsal V fractures in athletes and non-athletes. Br J Sports Med 46:644–648Google Scholar
  13. 13.
    Larson CM, Almekinders LC, Taft TN et al (2002) Intramedullary screw fixation of Jones fractures. Analysis of failure. Am J Sports Med 30:55–60PubMedGoogle Scholar
  14. 14.
    Lawrence SJ, Botte MJ (1993) Jones’ fractures and related fractures of the proximal fifth metatarsal. Foot Ankle 14:358PubMedCrossRefGoogle Scholar
  15. 15.
    Logan AJ, Dabke H, Finlay D et al (2007) Fifth metatarsal base fractures: a simple classification. Foot Ankle Surg 13:30–34CrossRefGoogle Scholar
  16. 16.
    Lombardi CM, Connolly FG, Silhanek AD (2004) The use of external fixation for treatment of the acute Jones fracture: a retrospective review of 10 cases. J Foot Ankle Surg 43:173–178PubMedCrossRefGoogle Scholar
  17. 17.
    Low K, Noblin JD, Browne JE et al (2004) Jones fractures in the elite football player. J Surg Orthop Adv 13:156–160PubMedGoogle Scholar
  18. 18.
    Mindrebo N, Shelbourne KD, Van Meter CD et al (1993) Outpatient percutaneous screw fixation of the acute Jones fracture. Am J Sports Med 21:720–723PubMedCrossRefGoogle Scholar
  19. 19.
    Mologne TS, Lundeen JM, Clapper MF et al (2005) Early screw fixation versus casting in the treatment of acute Jones fractures. Am J Sports Med 33:970–975PubMedCrossRefGoogle Scholar
  20. 20.
    Murawski CD, Kennedy JG (2011) Percutaneous internal fixation of proximal fifth metatarsal Jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes. Am J Sports Med 39:1295–1301PubMedCrossRefGoogle Scholar
  21. 21.
    Nunley JA (2001) Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am 32:171–180PubMedCrossRefGoogle Scholar
  22. 22.
    Popovic N, Jalali A, Georis P et al (2005) Proximal fifth metatarsal diaphyseal stress fracture in football players. Foot Ankle Surg 11:135–141CrossRefGoogle Scholar
  23. 23.
    Porter DA, Dobslaw R, Duncan M (2009) Comparison of 4.5-and 5.5-mm cannulated stainless steel screws for fifth metatarsal Jones fracture fixation. Foot Ank Int 30:27–33CrossRefGoogle Scholar
  24. 24.
    Porter DA, Duncan M, Meyer SJ (2005) Fifth metatarsal Jones fracture fixation with a 4.5-mm cannulated stainless steel screw in the competitive and recreational athlete: a clinical and radiographic evaluation. Am J Sports Med 33:726–733PubMedCrossRefGoogle Scholar
  25. 25.
    Quill GE Jr (1995) Fractures of the proximal fifth metatarsal. Orthop Clin North Am 26:353–362PubMedGoogle Scholar
  26. 26.
    Sarimo J, Rantanen J, Orava S et al (2006) Tension-band wiring for fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis. Am J Sports Med 34:476–480PubMedCrossRefGoogle Scholar
  27. 27.
    Seitz WH, Grantham SA (1985) The Jones’ fracture in the nonathlete. Foot Ankle 6:97–100PubMedCrossRefGoogle Scholar
  28. 28.
    Smith TO, Clark A, Hing CB (2011) Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base. Foot Ankle Surg 17:300–307PubMedCrossRefGoogle Scholar
  29. 29.
    Torg JS, Balduini FC, Zelko RR et al (1984) Fractures of the base of the fifth metatarsal distal to the tuberosity: classification and guidelines for non-surgical and surgical management. J Bone J Surg Am 66:209–214Google Scholar
  30. 30.
    Wright RW, Fischer DA, Shively RA et al (2000) Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med 28:732–736PubMedGoogle Scholar
  31. 31.
    Zelko RR, Torg JS, Rachun A (1979) Proximal diaphyseal fractures of the fifth metatarsal—treatment of the fractures and their complications in athletes. Am J Sports Med 7:95–101PubMedCrossRefGoogle Scholar
  32. 32.
    Zogby RG, Baker BE (1987) A review of nonoperative treatment of Jones’ fracture. Am J Sports Med 15:304–307PubMedCrossRefGoogle Scholar
  33. 33.
    Zwitser EW, Breederveld RS (2010) Fractures of the fifth metatarsal; diagnosis and treatment. Injury 41:555–562PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Chelsea and Westminster Hospital NHS Foundation TrustLondonUK
  2. 2.Fortius ClinicLondonUK

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