Fifth Metatarsal Fractures and Refractures

Fractures of the proximal fifth metatarsal metaphysis, commonly referred to as a Jones fracture, is a relatively common injury in athletes. This injury has been associated with unacceptably high rates of nonunion, refracture, and delayed return to activities with nonoperative treatment. As such, primary fixation is the accepted standard of care for the elite athlete. Fixation of the fracture allows safe, accelerated rehabilitation, higher healing rates, and earlier return to play. However, delayed union, nonunion, and refracture can occur despite surgical fixation and stabilization with evidence of healing. This article reviews indications and techniques for surgical treatment of Jones fractures, including refractures and nonunions, in the athletic patient.