How is a Jones fracture diagnosed
Fractures of the metatarsals and toes
Characteristic is the pain in the area of the injured bone region. There are swelling conditions, in some cases a bruise. The rolling movement is felt to be painful. Pressure pain also occurs.
Establishing the disease
In any case, an X-ray of the foot should be done in 2 planes. If there is no evidence of a fracture initially, it makes sense to repeat the X-ray after 2 weeks, as fractures sometimes only show up in the X-ray image after a delay. In the case of a purely lateral image, the diagnosis is more difficult due to the overlapping of the corresponding bones. An oblique recording is useful here. The fractures of the metatarsus and toes are divided into dislocated fractures (fragments are far apart) and non-dislocated fractures (the bone is untouched in shape and shape). Here, too, the blood circulation, motor skills and emotional perception must be checked in any case. In the area of the 5th metatarsal bone, at the end near the body, there is a fracture that has a special feature (Jones fracture). With restricted blood supply, an increased rate of incorrect healing can be recorded.
In the area of the 1st ray, conservative treatment can be undertaken if the fracture is not displaced. A lower leg cast is applied for 6 weeks and partial weight bearing is recommended for the relevant extremity. If the fragments are displaced (displaced fracture), a plate is placed on the bone when the fracture occurs in the shaft area.
If the break is more at the ends of the metatarsal bone, wires or screws are also recommended. Any fracture that radiates into the joint surface and has a displacement of more than 2 mm must be corrected by surgical measures and adjusted accordingly. Restoring the length is important in the area of the 1st ray in order to avoid problems such as persistent pain in the area of the 1st ray but also damage to the other rays from excessive stress. If the fractures of rays 2 to 5 are involved, shoes with a hard sole can be prescribed for non-displaced fractures and a pain-adapted load can be prescribed. If the fractures are postponed, it is advisable to set up the fracture (usually without opening the skin) and to wear a lower leg cast for 3 weeks. If several bones are involved, immobilization with a wire can be advantageous. This is then removed after 6 weeks. One should always think of dislocations in the nearby joints (Lisfranc joint, Chopart joint). These are serious injuries that require immediate surgical treatment. In the case of stress fractures, a lower leg walking cast is often applied or a hard orthosis, which should be worn for 3 weeks. A full load is possible here. However, the healing process should be followed with the help of the X-ray. If the break is in the area of the second ray near the body, the cast should be worn for 6 to 8 weeks, as the healing rates are often delayed. The non-displaced fracture in the area of the 5th ray at the base (Jones fracture) can initially be treated conservatively. A lower leg cast is recommended for 6 to 8 weeks. The lower extremity should be relieved for 4 to 6 weeks, after which it is increasingly possible to carry out a partial load. Athletes who need faster rehabilitation in order to be able to get back into the training process quickly, a fitting with a screw or a so-called tension strap (wires and cerclage) can be recommended. If this fracture is displaced, an open arrangement of the fracture is inevitable. Here the break must be surgically stabilized (screw, tension strap or plate).
If the toes are broken, fixation with a wire or screw may be necessary on the first ray, provided the break is in the toe area close to the body. Otherwise, an operation in the toe area is only necessary for severely displaced fractures. Broken toes are usually treated conservatively with the help of a plaster splint or in many cases only with splints by taping the adjacent toe (twin tape). If toes are dislocated, the pain can be switched off with local anesthesia and the bones can be moved into their anatomically sensible position by pulling and pulling. Bruising under the nails should be relieved in good time with a prick through the nail.
In some cases, splayfoot or flatfoot occurs after the accident, but this is rare. A healing disorder with the formation of a false joint (pseudarthrosis) is more common, especially in the so-called Jones fracture (fracture of the base of the 5th metatarsal).
In this case, the introduction of bone material from the iliac crest may be necessary, and compression by means of an implant (screw or tension strap) must be carried out at the same time. In any case, an injury to the so-called Lisfranc joint must be excluded in the initial diagnosis.
A serious complication is the so-called compartment syndrome, in which there is an increase in pressure in the muscle boxes of the foot. This causes severe pain, the soft tissues are very tense and there may be sensory disorders in the toe area. Immediate surgical treatment with relief of the boxes through one or more incisions in the area of the foot is indicated.
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