Stress vs Jones vs Avulsion Fracture

S-J-A: Order of 5th Metatarsal Base fractures

• Stress Fracture:
  - chronic pain
  - fracture lines are not sharp and has intramedullary sclerosis
  - harder to treat vs Avulsion fracture
  
• Jones Fracture: 1.5 cm distal to 5th Metatarsal tuberosity
  - acute fracture, not a stress fracture
  - True Jones Fracture is one inch distal to the base of the fifth metatarsal (Orthopedic Radiology,Adam Greenspan, 3rd edition)
  - from inversion foot injury
  - may need ORIF
  - peroneus tertius insertion
  
• Avulsion Fracture of 5th Metatarsal styloid: more proximal than Jones
  - most common 5th MT base fracture
  - due to peroneus brevis avulsion
  - heals quickly vs more distal ones (heals by fibrous union only)
  
  
• Dancer's Fracture (link at wheeless)
  - spiral frx of 5th metatarsal neck (distal shaft) which is common in ballet dancers
  - mechanism: inversion injury resulting from mis-steps & falls off the dem pointe position
  - mildly displaced: short leg csat 6-8 weeks
  - displaced ( 3-5 mm) may need ORIF
  

Jones Fracture Classification (Quill GE JR, CORR 1995;26:353)

1. Zone 1; Tuberosity Avulsion Fracture: fracture line extends into metatarsocuboid joint.
2. Zone 2; Jones Fracture: fracture in the meta-diaphyseal junction of the 5th metatarsal base in which the main fracture line extends into the 4th-5th metatarsal articulation (intermetatarsal facet).
3. Zone 3; Proximal Diaphyseal Fracture: generally stress fractures.

Link:
http://www.e-radiography.net/radpath/j/jones_fracture.htm
http://eorif.com/AnkleFoot/Jones%20FxIm.html