Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Fractures of proximal fifth metatarsal are one of the most common fractures of the foot. A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies. The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and nonunion in fractures at the metaphysealdiaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphysealdiaphyseal junction extending into the fourthfifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and nonunion, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report. Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, nonunion and refractures should be treated by revision fixation and bone grafting.