| Summary: | Category: Midfoot/Forefoot Introduction/Purpose: Operative management is the treatment of choice for Jones fracture. Situations are fought where operative management may not be possible or may not be accepted. Such situations being more common in developing countries, clinicians are forced to undertake conservative management. Pertain to this, many questions are still unanswered. Can conservative management succeed? If so, what should be the protocol? What all could be the possible complications? And how to overcome them? To answer all these questions, we undertook a study to evaluate results of conservative management of Jones fracture. The purpose of this study was also to suggest conservative management guidelines. Methods: Retrospective analysis of 32 conservatively treated Jones fracture cases over period of two years was done with average follow up of nine months. Only cases included were those between the ages of 20 to 50 years, not willing for operative management. Cases in the same age group, willing for surgery and cases lost to follow up were excluded. Conservative management comprised of full length below knee non weight bearing plaster cast in eversion and dorsiflexion for four weeks followed by short length below knee weight bearing plaster cast in neutral position of ankle and subtalar joint. Radiological evaluations were done at the end of 4, 8, 14, 20 and 26 weeks. Results of serial clinical and radiological assessments were analysed. Results: Thirty out of 32 cases went on to sound clinical as well as radiological union. With respect to average time to union, two major group of cases could be segregated. First group (20 cases) had a proximal fracture line nearer to zone 1 and took 11 weeks to unite. Second group (12 cases) had a distal fracture line nearer to zone 3 and took 18 weeks to unite. Both the nonunion cases were from this group. Clinical union preceded radiological union by average of 2 to 3 weeks. Conclusion: Jones fracture could be successfully treated conservatively even in young and active population provided specific protocol is followed. Initial full length below knee plaster in dorsiflexion and eversion neutralized deforming forces of peronei and plantar fascia while next short below knee walking plaster cast helped to regain muscle tone, increased perfusion and simulated walking leading to union. Fractures nearer the tuberosity had a faster union in comparison to distal fractures nearer the shaft. In view of short follow up with small numbers of present study, a multicentric prospective study comparing results of surgical versus conservative treatment is deemed.
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