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Jones fracture of the fifth metatarsal — MSRA MCQ

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HardAnkle and FootJones fracture of the fifth metatarsalMSRA

A 29-year-old recreational runner attends an urgent treatment centre 4 hours after an inversion injury to her right foot while stepping off a kerb. She immediately developed lateral foot pain and cannot take four steps. There is swelling and focal bony tenderness 1.8 cm distal to the fifth-metatarsal tuberosity. There is no ankle tenderness, skin wound, deformity or neurovascular deficit. Foot radiographs show a minimally displaced transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, extending into the fourth-fifth intermetatarsal articulation. There is no tuberosity avulsion fracture. What is the most appropriate management today?

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Correct answer: C — Apply a below-knee cast, instruct non-weight bearing with crutches, and arrange fracture-clinic review within 1 week

This is a Jones fracture: the fracture is at the metaphyseal-diaphyseal junction rather than the tuberosity, and extension into the fourth-fifth intermetatarsal articulation supports a zone 2 injury. Jones fractures have a clinically important risk of delayed union or non-union, so they require protected initial management and fracture-clinic follow-up rather than the functional approach used for a tuberosity avulsion fracture. The appropriate immediate plan is below-knee immobilisation, non-weight bearing with crutches, and fracture-clinic review within 1 week. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/34932521/?utm_source=openai)) A is appropriate for a fifth-metatarsal tuberosity avulsion fracture, for which weight bearing as comfort allows and no routine follow-up may be used, but not for this fracture pattern. B inadequately protects a Jones fracture during the initial phase. D is inappropriate because the radiograph already establishes the bony diagnosis; there is no examination finding suggesting peroneal tendon injury. E overcalls the immediate requirement: operative treatment may be considered subsequently, particularly if healing fails or for selected high-demand patients, but a minimally displaced, neurovascularly intact fracture requires initial immobilisation and specialist fracture review. ([esht.nhs.uk](https://www.esht.nhs.uk/wp-content/uploads/2026/01/2033.pdf))

Reference: Fracture of the base of the 5th metatarsal (Jones): Fracture Care Team Shared Care Plan (November 2025) — https://www.esht.nhs.uk/wp-content/uploads/2026/01/2033.pdf Fracture of the base of the 5th metatarsal (avulsion): Fracture Care Team Shared Care Plan (November 2025) — https://www.esht.nhs.uk/wp-content/uploads/2026/01/2032.pdf Fifth Metatarsal Jones Fractures: Diagnosis and Treatment (2022) — https://pubmed.ncbi.nlm.nih.gov/34932521/