Fractures and dislocations of the ankle and foot: The Daily PANCE Blueprint

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Fractures and dislocations of the ankle and foot: The Daily PANCE Blueprint

A 22-year-old male presents to the emergency department after twisting his ankle while playing soccer. He reports immediate pain and swelling around the outer aspect of his foot. Physical examination reveals tenderness over the lateral side of the foot, specifically over the 5th metatarsal. Radiographs of the foot are obtained, showing a fracture through the diaphysis of the 5th metatarsal. What is the name for a 5th metatarsal diaphysis fracture?

A. Jones fracture
B. March fracture
C. Lisfranc fracture
D. Pott's fracture
E. Avulsion fracture

Answer and topic summary

The answer is A. Jones fracture

A Jones fracture refers to a fracture of the 5th metatarsal diaphysis, specifically at the metaphyseal-diaphyseal junction, and is located approximately 1.5 to 3 cm distal to the tuberosity of the 5th metatarsal. This type of fracture is notorious for its poor healing due to the watershed area’s limited blood supply, making it prone to nonunion or delayed healing. Jones fractures are often caused by inversion injuries of the foot or direct trauma and may require surgical intervention for optimal healing, especially in athletes or active individuals.

Explanation for Incorrect Answers:

B. March fracture – A March fracture refers to a stress fracture of the metatarsals, commonly the 2nd or 3rd metatarsal, and is often seen in military recruits or athletes due to overuse, not the acute injury described in the vignette.

C. Lisfranc fracture – A Lisfranc fracture involves injury to the midfoot region, specifically the tarsometatarsal joints, and is not isolated to the 5th metatarsal diaphysis.

D. Pott’s fracture – Pott’s fracture refers to a fracture of the fibula near the ankle, often involving the tibia as well, and is associated with ankle injuries, not isolated 5th metatarsal fractures.

E. Avulsion fracture – An avulsion fracture of the 5th metatarsal occurs at the base and involves the tuberosity where the peroneus brevis tendon attaches, not the diaphysis. This type of fracture is different from a Jones fracture, which occurs in the diaphyseal region.

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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Lower extremity disorders ⇒ Fractures and dislocations of the ankle and foot