Rosenberg G A, Sferra J J
Kaiser-Permanente, Los Angeles, USA.
J Am Acad Orthop Surg. 2000 Sep-Oct;8(5):332-8. doi: 10.5435/00124635-200009000-00007.
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.
结节撕脱骨折、急性琼斯骨折和骨干应力性骨折。每种骨折类型都有其独特的损伤机制、发生部位、治疗选择以及关于延迟愈合和不愈合的预后情况。结节撕脱骨折是足部该区域最常见的骨折类型。大多数此类骨折通过在硬底鞋中进行对症治疗即可愈合。真正的琼斯骨折是一种涉及第四和第五跖骨间关节面的急性损伤。这些损伤最好采用非负重石膏固定6至8周进行治疗。据报道，采用这种治疗方法的愈合成功率在72%至93%之间。对于患有急性琼斯骨折的高水平运动员，早期髓内螺钉固定是一种可接受的治疗选择。第五跖骨近端的非急性骨干应力性骨折以及发展为延迟愈合和不愈合的琼斯骨折，都可以通过闭合轴向髓内螺钉固定或自体皮质松质骨移植进行手术固定来处理。早期使用电刺激的结果很有前景；然而，需要进行前瞻性研究以更好地确定这种治疗方式在处理这些损伤中的作用。
