The Jones fracture is a specific break in the foot, well-known particularly among athletes, due to its difficult healing process. This injury is a fracture of the fifth metatarsal bone, the long bone on the outer side of the foot leading to the little toe. The name of this complex injury comes from the prominent orthopedic surgeon who first identified it.
The Specific Location of the Injury
The fifth metatarsal is divided into three distinct zones. The Jones fracture is precisely defined as a break in the second zone, known as the metaphyseal-diaphyseal junction. This location is approximately 1.5 to 3 centimeters from the bone’s base, near the midfoot.
It is a transverse fracture, meaning it runs across the width of the bone shaft. Fractures occurring closer to the base (Zone 1) are typically avulsion fractures, often called pseudo-Jones or Dancer’s fractures, caused by a tendon pulling a small piece of bone away. The Jones fracture involves the bone shaft itself and is typically caused by indirect violence, such as a sharp twisting motion while the heel is off the ground.
The History of Sir Robert Jones
The fracture is named after Sir Robert Jones, a distinguished Welsh orthopedic surgeon (1857–1933). Jones was an early advocate for X-rays and helped establish orthopedics as a modern surgical specialty.
The discovery occurred in 1902 when Jones injured himself while dancing, landing on the outer side of his foot. He initially suspected a ruptured tendon. Using the new technology he championed, Jones had an X-ray performed on his own foot, which revealed a fracture about three-fourths of an inch from the base of the fifth metatarsal.
Jones recognized this was a previously undescribed pattern of injury, distinct from those caused by a direct blow. He published his findings in the Annals of Surgery in 1902, describing his own injury and five other similar cases. The paper, titled “Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence,” secured the eponym “Jones fracture.”
How the Fracture is Managed Today
A Jones fracture is diagnosed using X-rays, sometimes supplemented by CT or MRI to assess the full extent of the injury. The challenge in managing this fracture is rooted in its anatomy: the metaphyseal-diaphyseal junction has a limited blood supply, often called a vascular watershed zone. This poor circulation means the fracture is prone to delayed healing or nonunion, with rates reported as high as 15 to 30%.
Treatment depends on the patient’s activity level and fracture severity. Non-displaced fractures in less active individuals may be treated non-surgically with non-weight-bearing immobilization in a cast or boot for six to eight weeks. Due to the high risk of nonunion, especially in athletes or for displaced fractures, surgical intervention is often preferred. This surgery typically involves internal fixation with an intramedullary screw placed inside the bone to stabilize the fragments and promote healing.