Jones fracture
| Classification according to ICD-10 | |
|---|---|
| S92.3 | Metatarsal fracture |
| ICD-10 online (WHO version 2019) | |
The Jones fracture is a fracture of the fifth metatarsal near the base in the proximal meta - diaphyseal junction without involvement of the tarsometatarsal joint (but mostly the intermetatarsal joint to the fourth metatarsal ). This fracture is rarer than the avulsion fracture on the tuberosity with joint involvement, but the risk of non-healing ( pseudarthrosis ) is significantly higher, especially with conservative therapy.
The fracture, already known to the French surgeon Malgaigne in 1847, is named after the orthopedic surgeon Sir Robert Jones (1858–1933), who suffered this fracture himself during a dance in 1902 and then described it. In English, this fracture is sometimes and incorrectly also called dancer's fracture , although this term actually describes the avulsion fracture of the tuberosity and is synonymous with the "pseudo Jones fracture".
Anatomy and classification
The Jones fracture runs in the meta-diaphyseal junction transverse to the shaft axis about 1.5 to 2 cm distal to the tarsometatarsal joint, which is not involved. This area is poorly supplied with blood, which favors the development of pseudarthroses . The fracture is almost never shifted (dislocated). Often other fractures of the base of the fifth metatarsal are also referred to as "Jones fractures" or as "pseudo Jones fractures". A classification of the fractures of the fifth metatarsal was proposed by Dameron and Quill in 1995:
- Dameron-Quill type 1: avulsion fracture , Pseudo-Jones' fracture , dancer's fracture )
- Dameron-Quill type 2: fracture in the meta-diaphyseal junction ( true Jones' fracture )
- Dameron-Quill type 3: Stress fracture of the proximal shaft
- Dameron quill type 4: distal fractures of the shaft, neck or head
Other authors group types 2 and 3 together, since the stress fractures lie at about the same level in the meta-diaphyseal junction, and see type 3 as a delayed or unhealed Jones fracture ( chronic Jones' fracture ). Sclerotherapy of the medullary canal, a widened fracture gap and possibly the beginning of callus formation suggest a non-acute fracture, with complete obliteration of the medullary canal in pseudarthrosis. Torg and colleagues suggested a classification according to the decreasing healing potential.
- Torg type 1 - acute bone fracture
- Torg type 2 - fracture with delayed fracture healing in medullary canal sclerotherapy
- Torg type 3 - complete pseudarthrosis
In this study, 46 newly diagnosed fractures of types 2 and 3 according to Dameron-Quill (i.e. without involvement of the tarsometatarsal joint) were analyzed, and 25 times an acute fracture, 12 times an older, not yet healed bone fracture and nine times a complete pseudarthrosis were found.
A distinction must be made between a normal apophyseal plate, which exists between the ages of 9 and 14 years and runs along the axis of the shaft, and an accessory ossicle at the tip of the tuberosity at the base of the metatarsal V. This peroneum is seen in around 15% of people.
therapy
Due to the critical blood supply, healing is often delayed and osseous build-up is often only achieved after 8 to 10 weeks of immobilization. An osteosynthesis is often performed when mobility is quickly restored . For example, intramedullary screw osteosynthesis, tension straps with K-wire or mini-plate osteosynthesis are used.
literature
- S. Rammelt u. a .: Metatarsal fractures. In: Injury , 35, 2004, Suppl 2: SB77-86. PMID 15315882
Individual evidence
- ↑ K.-K. Dittel, K. Wiese: Complication Management in Traumatology . Thieme-Verlag, Stuttgart 2003, ISBN 3-13-129161-3
- ↑ Barbara I. Tshisuaka: Jones, Sir Robert. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 704.
- ↑ JS Torg et al. a .: Fractures of the base of the fifth metatarsal distal to the tuberosity. In: J Bone Joint Surg , 66, 1984, pp. 209-214. PMID 2197611 (Review)
