From Jones to avulsion: rethinking the fifth metatarsal base

Vollständiger Abstract

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Purpose of review Fifth metatarsal fractures are the most common metatarsal injury in the pediatric population; however, their management is frequently extrapolated from adult protocols. This review explores the emergence of pediatric-specific classification systems and evolving evidence on surgical versus conservative treatment in skeletally immature patients. Recent findings Anatomical and developmental differences critically distinguish pediatric fractures from adult fractures. Recent pediatric classifications, including those by Herrera-Soto and Lee, improve upon the widely used Dameron/Lawrence–Botte system by recognizing the apophysis as a distinct entity and offering better prognostic correlation. Zone 1 avulsion fractures achieve near-universal healing with conservative management. Emerging evidence supports surgical fixation with intramedullary screws for Zone 2 (Jones) fractures in adolescent athletes, whereas prepubertal patients respond well to conservative treatment. Nutritional factors, particularly vitamin D deficiency and inadequate calcium intake, are increasingly being recognized as modifiable risk factors for stress fractures and delayed union. Summary The management of fifth metatarsal fractures should be individualized according to the fracture zone, skeletal maturity, and activity level. Pediatric-specific classifications offer improved diagnostic accuracy. Nutritional optimization should be integrated into comprehensive management protocols, and further pediatric-focused clinical trials are needed.