to make the differentiation. An avulsion fracture at this location is typically extra-articular and oriented transversally as compared to the longitudinal orientation of an unfused apophysis. Treatment Casting Initial treatment is typically in a cast, without any weight being placed on it, for at least six weeks. If after this period of time healing has not occurred a further six weeks of casting may be recommended. Up to half, however, may not heal after casting. Surgery In athletes or if the pieces of bone are separated by more than 2 mm surgery may be considered. In a study of all players who entered the NFL Scouting Combine from 2009 to 2015, the incidence of Jones fracture was 3.2% and all had received surgery to repair the fracture with a metal screw. For persons who are not athletes, surgery might not be recommended unless healing does not occur after a trial of cast treatment. Prognosis For several reasons, a Jones fracture may not unite. The diaphyseal bone (zone II), where the fracture occurs, is an area of potentially poor blood supply, existing in a watershed area between two blood supplies. This may compromise healing. In addition, there are various tendons, including the fibularis brevis and fibularis tertius, and two small muscles attached to the bone. These may pull the fracture apart and prevent healing. Zones I and III have been associated with relatively guaranteed union and this union has taken place with only limited restriction of activity combined with early immobilization. On the other hand, zone II has been associated with either delayed or non-union and, consequently, it has been generally agreed that fractures in this area should be considered for some form of internal immobilization, such as internal screw fixation. These zones can be identified anatomically and on x-ray adding to the clinical usefulness of this classification. Surgical intervention is not, by itself, a guarantee of cure and has its own complication rate. Other reviews of the literature have concluded that conservative, non-operative, treatment is an acceptable option for the non-athlete. References External links Bone fractures Injuries of ankle and foot Wikipedia medicine articles ready to translate