Which is the most common type of fracture of the fifth metatarsal?

• A. Avulsion fracture (about 50%)
• B. Jones fracture
• C. Stress fracture
• D. Base fracture

Answer: (A)

Fifth metatarsal fractures most often occur as an avulsion at the tuberosity, pulled off by the peroneus brevis tendon during an inversion injury. This mechanism explains why about half of these fractures are tuberosity avulsions—the fragment is repeatedly pulled away from the base of the bone with relatively simple forces. The avulsion pattern is distinct from other types: a Jones fracture happens higher up, at the proximal diaphysis near the metadiaphyseal junction, and while common, it’s less frequent than tuberosity avulsions. Stress fractures involve repetitive loading of the diaphysis and are a different mechanism and location altogether. A base fracture is a broader descriptor that doesn’t pinpoint the tuberosity injury that many clinicians encounter most often. So the tuberosity avulsion is the most common presentation.