This is called the metaphyseal-diaphyseal junction. These fractures occur at the part of your fifth metatarsal close to the joint that meets the fourth metatarsal. Zone 2 fractures are also called Jones fractures. Zone 2 (Jones fracture of the 5th metatarsal) They’re sometimes called pseudo-Jones fractures. For example, if you land awkwardly after a jump or if you roll your ankle. Avulsion means “pulling or tearing away.” In an avulsion fracture, the bone is pulled off the fifth metatarsal bone by a tendon or ligament.Īvulsion fractures are often caused by an injury during an athletic activity. Zone 1 fractures, or avulsion fractures, involve the part of the fifth metatarsal that’s closest to your ankle. Zone 1 (avulsion fracture of the 5th metatarsal) Zone 3: proximal diaphyseal fractures, also called dancer’s fracture.Zone 2: fractures at the metaphyseal-diaphyseal junction, or Jones fracture.This system classifies fractures into three zones: A system known as the Lawrence and Botte classification is most frequently used today. Researchers have developed a classification system to help define the different types of fifth metatarsal fractures according to their location. People who have obesity or who experience sudden extreme weight gain may also be at risk of a stress fracture in the fifth metatarsal because the excess weight puts stress on the foot. It’s the result of overuse or repetitive actions, especially when you don’t allow yourself time to heal between activities. This is called a stress or hairline fracture. Repetitive stress from activities such as running, dancing, or sports such as soccer and basketball can lead to an eventual break in the fifth metatarsal over time. suddenly changing direction while running, walking, or dancing.landing awkwardly on the foot while jumping.getting the foot crushed in a football tackle.InjuryĪ fifth metatarsal fracture can be caused by an injury. In some cases, the fracture happens more slowly over time as stress on the foot builds up from repeated use. Sometimes they’re a result of trauma or injury. In contrast, fractures in zone III should primarily be treated surgically.Causes of fractures of the 5th metatarsalįractures of the fifth metatarsal can happen to anyone, but they’re more common in athletes and dancers. There seems to be no reason to consider zone I and II fractures as two separate entities, as the outcomes in the two groups are similar. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.įractures in zones I and II should be treated with early functional therapy. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. 46 days p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. The non-randomized studies revealed a faster return to full function (33 vs. 28 days p = 0.001), with otherwise similar outcomes. Two of these were randomized controlled trials (RCTs) in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. Nine studies compared different treatments of zone I fractures. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture. The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones zone II, in the area of the joint zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Nevertheless, no evidence-based treatment recommendations are available to date. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons.
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