There are at least three distinct fracture patterns that occur in the proximal fifth metatarsal: tuberosity avulsion fractures, acute Jones fractures, and diaphyseal stress fractures. Each of these fracture patterns has its own mechanism of injury, location, treatment options, and prognosis regarding delayed union and nonunion. Tuberosity avulsion fractures are the most common in this region of the foot. The majority heal with symptomatic care in a hard-soled shoe. The true Jones fracture is an acute injury involving the fourth-fifth intermetatarsal facet. These injuries are best treated with non-weight-bearing cast immobilization for 6 to 8 weeks. The rate of successful union with this treatment has been reported to be between 72% and 93%. For the high-performance athlete with an acute Jones fracture, early intramedullary-screw fixation is an accepted treatment option. Nonacute diaphyseal stress fractures of the proximal fifth metatarsal and Jones fractures that develop into delayed unions and nonunions can both be managed with operative fixation with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting. Early results with the use of electrical stimulation are promising; however, prospective studies are needed to better define the role of this modality in managing these injuries.

译文

:在fifth骨近端至少发生三种不同的骨折类型:结节撕脱性骨折,急性琼斯骨折和骨干应力骨折。这些骨折类型中的每一种都有其自身的损伤机制,部位,治疗选择以及关于延迟愈合和不愈合的预后。结节撕脱性骨折最常见于脚部区域。大部分人在对鞋硬底的情况下对症治疗。真正的琼斯骨折是涉及第四至第五间间小平面的急性损伤。这些损伤最好用非承重石膏固定器治疗6至8周。据报道,采用这种治疗方法的成功结合率在72%至93%之间。对于具有急性琼斯骨折的高性能运动员,早期的髓内螺钉内固定是一种可以接受的治疗选择。近端第五meta骨的非急性干phy端应力性骨折和发展为延迟性联合和骨不连的琼斯骨折都可以通过闭合性轴向髓内螺钉内固定或自体皮质突状骨移植术进行手术固定。使用电刺激的早期结果很有希望;但是,需要进行前瞻性研究,以更好地定义这种方式在管理这些伤害中的作用。

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