Minimally displaced Jones fractures can be managed with immediate weight-bearing in walking boot

Aurora, CO, USA: Jones fractures have a high risk for non-union due to a vascular watershed region. Classically, treatment consists of weight bearing restrictions in a cast or surgical fixation. Some studies have assessed immediate weight bearing following a Jones fracture. Due to conflicting results, the most appropriate treatment method remains unclear.

N. Look et al. conducted a study to analyze outcomes after treating adults with acute Jones fractures non-operatively without weight bearing restrictions in a walking boot. This study hypothesizes that patients will not require future operative intervention following functional treatment.

• A retrospective review of 55 adult patients who sustained acute, closed Jones fractures was conducted.

• 47 were treated weight bearing as tolerated (WBAT) in a walking boot and eight were treated non-weight bearing (NWB) in a cast.

• They were followed radiographically by an orthopedic surgeon for an average of 6.4 and 15.5 months, respectively.

• Three patients in each group (6.4% WBAT, 37.5% NWB) developed painful nonunion leading to surgical fixation.

• Thirty (66.7%) patients in the WBAT group demonstrated radiographic union on final radiographs.

• Only two (13.3%) of the 15 patients with partial union were seen at least six months from time of injury, one of whom had ongoing pain but declined surgery.

• The remaining 13 patients were asymptomatic at their final clinic appointment.

The authors concluded that - multiple medical specialties are involved in the evaluation and treatment of Jones fractures, but controversy still exists regarding the best treatment methodology for acute Jones fractures. This study results support the treatment of acute, minimally displaced Jones fractures in the low-demand, adult (non-elite athlete) population as weight bearing without restrictions in a walking boot. This treatment method has the potential to decrease the need for casting, prolonged follow-up, and burden on older patients to maintain weight bearing restrictions, while maintaining satisfactory outcomes. The increased evidence of successful treatment in a walking boot may help alter how other medical specialties manage acute Jones fractures.

Key Words: Jones fractures Fifth metatarsal fracture Functional treatment Outcomes

Further reading:

Conservative management of Jones fractures with immediate weight-bearing in a walking boot demonstrates healing.

Nicole Look, Colin R. Reisenauer, Melissa A. Gorman

The Foot 50 (2022) 101870

https://doi.org/10.1016/j.foot.2021.101870