Jones Fracture Fixation

Overview

A Jones fracture is a specific break at the base of the fifth metatarsal, the long bone along the outer edge of the foot. The break sits in a zone where the bone's blood supply is naturally sparse, and bone cannot heal without blood. That is why these fractures are prone to healing slowly (delayed union) or not at all (nonunion), especially in athletes and in patients with high activity demands.

Operative fixation is often preferred for active people and athletes who want a quicker, more predictable return to sport. Non-operative treatment with strict non-weight-bearing casting remains an option, particularly if you are less active, but takes longer and carries a higher risk of the bone failing to heal (nonunion).

Why it's done

ORIF stands for open reduction and internal fixation: the bone is realigned in surgery and held in position with hardware. It is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

Active or athletic patient
A more predictable return to cutting and running sports.
Displaced fracture
Displacement lowers the already-marginal healing rate.
Delayed or nonunion from prior non-operative care
A screw, often with bone graft or another biologic boost to healing, can salvage a stalled fracture.
Chronic stress reaction at the Jones site
Fixing the bone before it breaks completely (prophylactic fixation) may be appropriate in an in-season athlete.

How it works

Through a small incision at the base of the fifth metatarsal, a solid screw is driven down the hollow center of the bone (the medullary canal) under real-time X-ray guidance (fluoroscopy). The screw compresses the fracture and acts as an internal splint.

In high-risk patients or in nonunion cases, bone graft or biologic augmentation may be added.

Recovery

You will typically be non-weight-bearing in a boot during early recovery, then allowed to gradually increase weight-bearing while still in the boot. Return to running and cutting activity is held until X-rays confirm the bone has healed. Screws are left in place unless they cause symptoms. Re-fracture through or around the screw is a known risk, particularly if you return to sport before healing is confirmed on imaging.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.

Physicians Who Perform Jones Fracture Fixation

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Weight-Bearing After Repair

Controlled load is part of how bone heals. Once the fracture is held in place with hardware, putting gentle weight through the limb helps the bone heal. Keeping all weight off a fixed fracture for too long can actually slow healing and stiffen the nearby joints. Full body weight right away, however, can be too much before the bone has caught up. The right answer sits in between: how much weight you can put on the foot, and when to add more, is decided by your surgeon based on your fracture, the strength of the repair, your bone, and how things look on your X-rays after surgery. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.

Risks & Why We Still Recommend It

Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a non-union at the base of the fifth metatarsal, a zone with notoriously poor blood supply that often fails to heal in a cast. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.

Before this surgery, we go over the following risks with you:

bleeding and infection
anesthesia risk
irritation of the sural nerve, the sensory nerve along the outer border of the foot
the bone failing to heal (non-union) or re-breaking despite fixation
hardware irritation requiring later removal
stiffness

The indication to proceed is a true Jones fracture (at the junction between the base and shaft of the fifth metatarsal) in an athlete, or in anyone who cannot accept the nonunion risk of cast treatment. If this operation is not right for your situation, we will not recommend it.

Frequently Asked

questions we hear in clinic

Can this fracture heal without surgery?

Sometimes. Non-operative treatment with strict non-weight-bearing casting remains an option, particularly if you are less active, but it takes longer and carries a higher risk of the bone failing to heal. Fixation is often preferred for active people and athletes who want a quicker, more predictable return to sport.

Why is this particular break so slow to heal?

The fracture sits in a zone where the bone's blood supply is naturally sparse, and bone cannot heal without blood. That is why Jones fractures are prone to healing slowly (delayed union) or not at all (nonunion).

Will I be in a cast or a boot?

You will typically be non-weight-bearing in a boot during early recovery, then allowed to gradually increase weight-bearing while still in the boot.

When can I run again?

Return to running and cutting activity is held until X-rays confirm the bone has healed. Re-fracture through or around the screw is a known risk, particularly if you return to sport before healing is confirmed on imaging.

Does the screw come out later?

Screws are left in place unless they cause symptoms. Hardware irritation requiring later removal is one of the risks we go over before surgery.

What if my fracture already failed cast treatment?

A screw, often with bone graft or another biologic boost to healing, can salvage a stalled fracture. In high-risk patients or in nonunion cases, that augmentation may be added at the time of fixation.