Avulsion fracture of the 5th metatarsal styloid

Last revised by Mohammadtaghi Niknejad ◉ on 9 Feb 2023

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Niknejad M, Hacking C, et al. Avulsion fracture of the 5th metatarsal styloid. Reference article, Radiopaedia.org (Accessed on 07 Jun 2023) https://doi.org/10.53347/rID-952

DOI:

https://doi.org/10.53347/rID-952

Permalink:

https://radiopaedia.org/articles/952

rID:

952

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

9 Feb 2023, Mohammadtaghi Niknejad ◉

Disclosures:

At the time the article was last revised Mohammadtaghi Niknejad had no recorded disclosures.

View Mohammadtaghi Niknejad's current disclosures

Revisions:

49 times, by 18 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Trauma

Tags:

foot, fracture

Synonyms:

Pseudo-Jones fracture
Avulsion fracture of the fifth metatarsal styloid
Avulsion fracture of the proximal fifth metatarsal
Proximal 5th metatarsal avulsion fracture
Tennis fracture
Avulsion fracture of the proximal 5th metatarsal
Avulsion fracture 5th metatarsal styloid
Dancer fracture

Avulsion fracture of the 5^th metatarsal styloid, also known as a pseudo-Jones fracture or a dancer fracture, is one of the more common foot avulsion injuries and accounts for over 90% of fractures of the base of the 5^th metatarsal.

Despite what should be a simple entity, controversy exists, as well as confusion in the literature, with the term Jones fracture sometimes liberally (and incorrectly) applied to this fracture.

Traditionally this avulsion fracture has been ascribed to the insertion of peroneus brevis and is caused by forcible inversion of the foot in plantar flexion, as may occur while stepping on a curb or climbing steps. It is for this reason that the 5^thmetatarsal base must be included in the lateral ankle projection of an ankle series, especially when performed for an inversion injury.

It is also relatively common among tennis players, accounting for it sometimes being referred to as a "tennis fracture".

Some authors believe that it is due to the lateral cord of the plantar aponeurosis which also inserts at the base, rather than the peroneus brevis tendon ².

Radiographic features

Small fracture usually of the tuberosity of the proximal 5^th metatarsal, oriented mostly transversely (cf. apophysis which parallels the shaft). It usually does not reach the tarsometatarsal (metatarsocuboid) joint, but occasionally does.

In some instances, the fracture may be occult.

Treatment and prognosis

In general, these fractures can be treated conservatively, and heal well ². Functional weight-bearing such as Robert Jones bandage or elastic bandaging and stiff-soled shoes has better outcomes than non-weight-bearing in a short leg cast ⁵.

For large or very displaced fragments with intra-articular extension then operative fixation may be indicated.

Differential diagnosis

A number of fractures occur at the base of the 5^th metatarsal (see fractures of the proximal fifth metatarsal) as well as entities that mimic fractures:

Jones fracture: at the metaphysis-diaphysis junction, at the level of the fourth-fifth intermetatarsal articulation
stress fracture of the 5^thmetatarsal: at the proximal diaphysis, distal to the level of the fourth-fifth intermetatarsal articulation
os peroneum
os vesalianum pedis
normal apophysis of the proximal 5^th metatarsal