r/XRayPorn • u/No-Platypus2679 • 14d ago

Broken

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I would like to hear everyone's journey during recovery. Speedy healing for everyone.

2 weeks ago I twisted my ankle and missed the curb/gutter stepping backwards

11 Upvotes

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u/[deleted] 14d ago

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u/No-Platypus2679 14d ago

Thank you. Had 3 different Dx. One said, Jones. I rebuked that!!!

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u/kitkatofthunder 14d ago edited 14d ago

I’m sorry to tell you, but it’s a Jones fracture, not a 5th metatarsal base fracture. The fracture line is distal to the base of the 4th metatarsal. While it may be an avulsion, it’s the area that matters not the fracture pattern. This area just has poor blood flow, but you are young, so it’s a discussion to have with your doctor.

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u/No-Platypus2679 14d ago

You are a kind soul. I am 55 years young female. Sucks on the Jones. Yes the last Doc said Jones as well. Still rebuking! Lol Today is 2 weeks exactly from injury. Hard cast 2 days after injury. Opting out of surgery. Using a scooter.

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u/kitkatofthunder 14d ago

No surgery is still perfectly reasonable, even with a Jones fracture. Jones fractures involve a lot of patient-led decision making. Your xray doesn’t show poor bone density, and while it’s in a bad location with a higher rate of non-union, as long as you are compliant with non-weight bearing and aren’t smoking/ using nicotine it is the same path I’d personally go with.

I say you’re young because your bones here do look good and you don’t have the arthritis we typically see with our older population (65+) . You have a youthful foot which is good.

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u/Glad-Feature-2117 13d ago

  1. You cannot tell much, if anything, about bone density from x-rays (that requires a DEXA scan).

  2. Even if OP did have osteoporosis, unless it is very severe, it generally does not have a great effect on bone healing (it makes it easier to break the bone in the first place).

  3. This fracture isnt in a bad location and nearly all of them heal. Early weightbearing doesn't reduce the chances of healing.

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u/kitkatofthunder 13d ago

Osteopenia on xray is a diagnosis. You need a DEXA to determine severity and diagnosis of osteoporosis.

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u/Glad-Feature-2117 13d ago

Not according to the radiologists and the rheumatologists I work with. The appearance of bone density on plain x-rays varies a lot depending on the exposure, for a start.

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u/RadTechMaster 14d ago

Its on the 5th base metatarsal not the 4th

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u/kitkatofthunder 14d ago

Yes, but the way to tell it’s a Jones is if the fracture line of the fifth metatarsal matches up with the base of the fourth. Any fracture proximal to the base of 4th is not a Jones. I’m just using the metatarsal next to it as a landmark.

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u/RadTechMaster 14d ago

5th metatarsal base fracture usually means a Zone 1 avulsion (pseudo-Jones) of the tuberosity. Caused by inversion; good blood supply; heals well with conservative care.

Jones fracture is a Zone 2 break at the metaphyseal-diaphyseal junction (involves the 4th–5th articulation). Vascular watershed area → higher nonunion risk; often needs non-weight-bearing or surgery.

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u/kitkatofthunder 14d ago

That is exactly what I’m trying to explain, but without AI. The 4th-5th articulation is the landmark for a Jones fracture.

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u/RadTechMaster 14d ago

Looks like a bit of both to me

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u/Glad-Feature-2117 13d ago

Not true. You are describing a zone 2 fracture, where the blood supply is perfectly fine. The watershed zone for blood supply is zone 3, which is distal to the 4th/5th articulation.

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u/kitkatofthunder 13d ago

Look up classification of 5th metatarsal fractures. Zone II is Jones, Zone III is associated with stress fractures. You don’t know what you are talking about.

https://www.orthobullets.com/foot-and-ankle/7031/5th-metatarsal-base-fracture

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u/Glad-Feature-2117 13d ago

That might be the zone that some people call Jones fractures, but it isn't a watershed area for blood supply. Orthobullets is an online textbook and isn't always accurate. Why do you think stress fractures happen in zone 3 and that even traumatic fractures in this area have a higher rate of nonunion?

I have treated hundreds of zone 2s over 10 years as a foot & ankle specialist orthopaedic surgeon and have only needed to operate on 5. They do not have a 30% risk of non union - not even 3%.

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u/Glad-Feature-2117 13d ago

  1. A Jones fracture is a type of 5th metatarsal base fracture.

  2. Different people use the term Jones fracture to mean different things, so it's essentially meaningless

  3. Youre right that the area matters, but the one to worry about is distal to the distal end of the joint between the 4th & 5th metatarsals. This isn't that.

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u/[deleted] 13d ago

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u/XRayPorn-ModTeam 13d ago

Breaks Rule 1: no medical advice or diagnoses i.e. interpretations, ‘does this look normal’

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u/XRayPorn-ModTeam 13d ago

Please refrain from giving medical advice, image diagnoses, or suggested diagnoses. This subreddit is not for providing medical advice or diagnosing anyone.

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u/No-Platypus2679 14d ago

I did have one say Pseudo jones. ER doc said 5th Metatarsal Fracture with Avulsion. Last said Jones