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An avulsion fracture is called a pseudo-Jones fracture, whereas a Jones fracture is considered a transverse fracture.
A fracture is a break or discontinuity in the bone. It can be classified based on the etiology (which is the cause), relationship with the environment, displacement of the fractured bone, and pattern of fracture.
When a tendon or ligament pulls off a piece of the bone, it leads to an avulsion fracture. The tendon attaches muscles to bones and the ligament attaches bones to bones. An avulsion fracture occurs in a bone due to a strong traction force by the tendons and ligaments attached to it.
The Jones fracture occurs at the site of metatarsals (five long bones found in the foot).
An avulsion fracture of the fifth proximal metatarsal at its base is called a pseudo-Jones fracture or a dancer fracture. This is one of the most common foot avulsion injuries, accounting for approximately 90 percent of all fractures at the base of the fifth metatarsal.
A Jones fracture, however, is a transverse fracture through the proximal fifth metatarsal bone in the metaphyseal-diaphyseal junction.
What causes an avulsion fracture?
Most athletes and people who lead an active lifestyle tend to get this type of fracture.
Situations that can lead to avulsion fractures are:
- Weightlifting without proper warm-up exercises
- Kicking something too hard
- Sprinting
- Falling on an outstretched hand
- Leaping
How is an avulsion fracture diagnosed?
Clinical symptoms are often suggestive of the fracture. All fractures can be diagnosed by X-ray.
However, a magnetic resonance imaging or computed tomography scan could be done, which shows a precise degree of avulsion as well as the surrounding soft tissue damage.
Symptoms that a person has an avulsion fracture include:
- Bruising or contusion
- Swelling
- Muscle pain
- Pain radiating to surrounding structures
- Limping
- Restriction of movement of the joint
How is an avulsion fracture treated?
Treatment of a fracture can be done in the following three phases:
- Phase I, emergency care: Emergency care of a fracture begins at the site of the accident and consists of RICE, which means
- Rest to the part by splinting
- Ice therapy is done to reduce swelling
- Compression to reduce swelling
- Elevation to reduce swelling
- Phase II, definitive care: There are three fundamental principles of definitive care.
- Reduction: “Setting” the displaced fracture to proper alignment. This may be done nonoperatively or operatively and is called closed and open reduction, respectively.
- Immobilization: The bones are maintained in a reduced position. This may be done by external immobilization, such as by application of plaster or by internal fixation of the fracture using rods, plates, screws, etc.
- Preservation of function: To preserve the functions of the limb, physiotherapy throughout the treatment, even when the limb is immobilized, is important.
- Phase III, rehabilitation of fractured limb: This begins at the time of injury and continues until maximum possible functions have been regained, consisting of
- Joint mobilization
- Muscle reeducation exercises
- Instructions regarding gait training
Surgical management of avulsion fractures
Generally, an avulsion fracture does not need surgical interventions.
However, in certain cases, one might need to undergo surgery if the fracture is 2 cm away from the main bone.
The two following surgical procedures are often performed:
- Open reduction: The surgeon makes an incision and aligns the bone.
- Internal fixation: In this method, once the fracture is reduced, it is held internally with the help of a metallic or nonmetallic implant, such as steel wire, screw, plate, Kirschner wire (K-wire), and intramedullary nail. These implants are made of superior quality stainless steel to which the body is inert.
- Indications: Internal fixation of fractures may be considered under the following circumstances:
- When the fracture is so unstable that it is difficult to maintain it in an acceptable position by nonoperative means. This is the most common indication for internal fixation.
- A treatment of choice in some fractures to ensure rigid immobilization and promote early mobility of the patient.
- Indications: Internal fixation of fractures may be considered under the following circumstances:
How do you reduce the risk of an avulsion fracture?
A few simple cautionary steps can decrease the risk of an avulsion fracture, such as:
- One should do proper warm-up exercises before hitting the gym.
- Know your body’s limitations and do not push yourself to extremes while doing vigorous physical activities.
- Good quality exercise gear is essential during workouts.
