Twenty-two patients with twenty-three fractures of the proximal part of
the diaphysis of the fifth metatarsal, an injury originally described by
Jones, are reported. The average follow-up was 3.5 years. Delayed union
occurred in twelve (66.7 per cent) of eighteen patients treated
conservatively. Four patients were operated on within two weeks of injury.
The clinical picture in nine of the twenty-two patients suggested that the
injury was a stress fracture. Force-platform analysis in eleven cases
confirmed that the injury results from vertical and mediolateral forces
concentrated over the fifth metatarsal and that it is not caused by
inversion. Thirteen of the twenty-three fractures were in young athletes,
often occurring during training and causing significant disability. In this
group of patients, and in a select number of recreational athletes and
non-athletes with delayed union, intramedullary screw fixation of the
fracture is advised.