JAAOS - 2026-06-22 - Journal Article
Clinical Outcomes and Complications of Surgical and Conservative Treatment for Jones Fractures: A Systematic Review.
Encinas R, Hall Kiriluk S, DePaolo S, Jackson JB, Shaath MK, Gonzalez T
Topics
Key Takeaway
Surgical fixation of Jones fractures yields a significantly lower nonunion rate (3.3% vs 11.6%) and higher AOFAS scores (96.5 vs 84.1) compared to conservative management across 998 patients.
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Summary
This systematic review compared surgical fixation versus conservative management for Zone 2 fifth metatarsal (Jones) fractures across 10 studies and 998 patients (211 surgical, 787 conservative). Surgical patients had significantly lower total complication rates (8.5% vs 15.6%, P=0.02), lower nonunion rates (3.3% vs 11.6%, P=0.04), and superior AOFAS scores at final follow-up (96.5 vs 84.1, P=0.005). The review concludes surgical management produces superior outcomes, though conservative treatment remains a viable option.
Key Limitation
The marked disparity in cohort sizes (787 conservative vs 211 surgical) combined with the absence of patient activity level or Torg subtype stratification makes it impossible to exclude selection bias as the primary driver of outcome differences.
Original Abstract
BACKGROUND
Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management of these injuries remains without clear guidelines. Accordingly, the goal of the current systematic review is to compare the clinical outcomes and complications for both surgical fixation and conservative treatment.
METHODS
Two independent authors completed a systematic review using the PubMed, EMBASE, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and Cochrane Handbook guidelines were followed. In addition, the Methodological Index for Non-Randomized Studies score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our criteria included only studies that reported on both conservative and surgical treatment of Jones fractures.
RESULTS
Ten studies including 998 patients met our criteria for inclusion. A total of 787 patients underwent conservative management while 211 patients underwent surgical fixation. The surgical cohort had a significantly lower rate of total complications (18/211 (8.5%)) in comparison with the conservative cohort (123/787 (15.6%; P = 0.02). Similarly, those who underwent surgery had a lower rate of nonunion (7/211 (3.3%) versus 91/787 (11.6%; P = 0.04)). Patient-reported outcome scores, including American Orthopaedic Foot and Ankle Society scores were significantly better at final follow-up in the surgical group (96.5) in comparison with the conservative group (84.1; P = 0.005).
CONCLUSION
This systematic review found markedly fewer total complications, a lower nonunion rate, and higher mean American Orthopaedic Foot and Ankle Society scores in patients who underwent surgical management for Jones fractures in comparison with those who were treated nonoperatively. Although, conservative treatment is also a successful method of treatment, our findings support surgical treatment of Jones fractures.