The Proximal Fifth Metatarsal Metadiaphyseal Jones Fracture: Intramedullary Screw vs Plantar Plate

Proximal metaphyseal-diaphyseal (zones 2 or 3) fifth metatarsal fractures, or Jones fractures as they are commonly called, occur frequently in the athletic population. These fractures are challenging both biologically and biomechanically. Although operative treatment of these fractures in high-performance athletes is recommended, there is still a significant reported incidence of delayed healing or refracture after fixation. Intramedullary screw fixation has traditionally been the gold standard of surgical treatment. A solid, partially threaded, and intramedullary screw is the implant of choice, placed “high and inside” to achieve optimal fracture fixation. However, the intramedullary screw may not be the ideal construct owing to its inability to resist rotational stress as well as other constructs, potentially leading to poor healing or refracture. Plantar plating is an alternative treatment that may provide superior biological and biomechanical advantages. This article describes clinical outcomes and surgical techniques for both intramedullary screw fixation and plantar plate open reduction and internal fixation of fifth metatarsal metaphyseal-diaphyseal fractures.