A 45-year-old man presents with a fracture of the base of the 5th metatarsal extending into the metaphyseal-diaphyseal junction (Jones zone), without involvement of the 4th–5th intermetatarsal articulation. The most appropriate treatment is:

• A Buddy strapping and weight-bearing as tolerated
• B Short-leg non–weight-bearing cast for 6–8 weeks
• C Plate fixation with bone grafting
• D Intramedullary screw fixation (4.5 mm solid screw) ✓

Explanation

The Jones fracture (zone 2 — metaphyseal-diaphyseal junction of the 5th metatarsal) has a notoriously poor blood supply and high non-union rate (non-union in up to 50% with cast alone). In active, athletic, or high-demand individuals, intramedullary screw fixation with a 4.5 mm cannulated solid screw is the treatment of choice for faster return to activity and lower non-union rate. Zone 1 (tuberosity avulsion) fractures heal with symptomatic treatment. Plate fixation is not standard for this fracture.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.