The base of the fifth metatarsal has three distinct zones relevant to fracture classification: Zone 1 is the tuberosity (styloid process) where peroneus brevis inserts, fractured by avulsion in ankle inversion injuries; Zone 2 is the metaphyseal-diaphyseal junction (Jones fracture zone), a watershed area between the metaphyseal and diaphyseal blood supplies with high non-union risk; Zone 3 is the proximal diaphysis, the site of stress fractures in dancers and athletes.
The fifth metatarsal base is one of the most frequently fractured bones of the foot. Zone 1 tuberosity avulsion fractures from peroneus brevis pull in ankle inversion are benign and treated conservatively with weight-bearing as tolerated. Zone 2 Jones fractures at the watershed metaphyseal-diaphyseal junction have high non-union rates due to poor blood supply and require non-weight-bearing cast or surgical fixation with an intramedullary screw for athletes. Zone 3 stress fractures require extended non-weight-bearing and often surgical fixation.
Zone 2 fracture of the fifth metatarsal base at the metaphyseal-diaphyseal junction in the watershed blood supply area carries a high non-union risk with conservative treatment; athletes require primary fixation with a 4.5-6.5 mm intramedullary screw to allow early return to sport and reduce non-union risk compared to cast immobilisation.
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