我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
FRACTURES OF THE FIFTH METATARSAL BASE
Forced inversion of the foot (the 'pot-hole injury’) may cause avulsion of the base of the fifth metatarsal, with pull-off by the peroneus brevis tendon or the lateral band of the plantar fascia. Pain due to a sprained ankle may overshadow pain in the foot. Examination will disclose a point of tenderness directly over the prominence at the base of the fifth metatarsal bone.
A careful assessment of the fracture pattern will provide a guide to prognosis and treatment. Again, an appreciation of the patho-anatomy explains these factors.
The fifth metatarsal base extends much more proximal into the midfoot region, compared to the other metatarsal bases. It articulates with the cuboid and with the fourth metatarsal. The peroneus brevis tendon and lateral band of the plantar fascia insert onto the base of the fifth metatarsal. There is a relative watershed in the blood supply to the fifth metatarsal at the junction between the diaphysis and metaphysis.
Robert Jones, a founding father and doyen of orthopaedics, described his own fracture (sustained whilst dancing), as a fracture of the fifth metatarsal about three-fourths of an inch from its base. Unfortunately, as observed above with Pott’s fractures, what has passed into history as this eponymous fracture is often not what was actually described, and the term 'Jones fracture’ is now sometimes used for any fracture of the proximal fifth metatarsal. A more useful classification system takes account of the fracture line, and whether it is proximal, affecting the tuberosity, in the region of articulation with the fourth metatarsal, or at the metaphyseal/diaphyseal junction – the latter has a higher rate of non-union, probably as a consequence of the relatively poor blood supply in that region.
Occasionally a normal peroneal ossicle in this area may be mistaken for a fracture; there is also an apophyseal ossification centre in the tuberosity.
Treatment
The proximal avulsion fractures can usually be treated symptomatically, with initial rest and support, but with early mobilization and return to function.
The intra-articular injuries and those at the metaphyseal–diaphyseal junction may also be treated nonoperatively, but there is a greater risk of non-union and slower return to function. The role of fixation with an interfragmentary screw or screws and plate is therefore an issue for discussion between the surgeon and the patient, depending to a large extent on the patient’s functional demands and expectations with respect to sport, activity, and time away from these.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Forced inversion of the foot (the 'pot-hole injury’) may cause avulsion of the base of the fifth metatarsal强迫性的脚内翻（"坑洞损伤"）可能导致第五跖骨基底的撕脱
avulsion /əˈvʌlʃən/n. 扯开，撕裂；扯离的部分
peroneus brevis tendon 腓骨短肌腱
plantar fascia足底筋膜 脚底筋膜炎 跖腱膜
fascia/ˈfeɪʃə/n. 招牌；[医] 筋膜；绷带；饰带
Pain due to a sprained ankle may overshadow pain in the foot。脚踝扭伤引起的疼痛可能会掩盖脚部的疼痛
over the prominence at the base of the fifth metatarsal bone.在第五跖骨底部的凸起处。
prominence /ˈprɑːmɪnəns/n. 重要，著名；突起，凸出
It articulates with the cuboid and with the fourth metatarsal.它与筛骨和第四跖骨相连。
articulate/ɑːrˈtɪkjuleɪt/vt. 清晰地发（音）；明确有力地表达；用关节连接；使相互连贯vi. 发音；清楚地讲话；用关节连接起来adj. 发音清晰的；口才好的；有关节的
watershed /ˈwɔːtərʃed/n. （美）流域；分水岭；集水区；转折点
diaphysis and metaphysis骨干和干骺端
a founding father and doyen开国元勋（创始人）和元老
doyen /ˈdɔɪən/n. 首席；老资格；老前辈
ossification centre骨化中心
DeepL翻译（仅供参考，建议自己翻译）：
第五跖骨基底的骨折
强迫性的脚内翻（"坑洞损伤"）可能导致第五跖骨基底的撕脱，由腓肠肌肌腱或足底筋膜的外侧带拉断。踝关节扭伤引起的疼痛可能会掩盖脚部的疼痛。检查会发现在第五跖骨底部的突出部位有一个触痛点。
对骨折模式的仔细评估将为预后和治疗提供指导。同样，对病理解剖学的理解可以解释这些因素。
与其他跖骨基底相比，第五跖骨基底向足中部区域延伸得更近。它与立方体和第四跖骨相衔接。腓肠肌肌腱和足底筋膜的外侧带插入第五跖骨基底。在干骺端和干骺端的交界处，第五跖骨的血液供应有一个相对分水岭。
罗伯特-琼斯是骨科的奠基人和奠基人，他将自己的骨折（跳舞时发生的）描述为第五跖骨的骨折，距其基部约四分之三英寸。不幸的是，正如上文对Pott的骨折所观察到的那样，作为这种同名的骨折进入历史的往往不是实际描述的那样，现在 "Jones骨折 "一词有时被用于任何第五跖骨近端骨折。一个更有用的分类系统考虑到了骨折线，以及它是否在近端，影响到小瘤，在与第四跖骨衔接的区域，或在干骺端/干骺端交界处--后者的不愈合率较高，可能是因为该区域的血液供应相对较差。
偶尔在这个区域的正常的腓骨骨膜可能被误认为是骨折；在小结节处也有一个骨骺线骨化中心。
治疗方法
近端撕脱性骨折通常可以对症治疗，最初是休息和支持，但要尽早动员和恢复功能。
关节内的损伤和在干骺端交界处的损伤也可以采用非手术治疗，但不愈合的风险更大，恢复功能也更慢。因此，用骨间螺钉或螺钉和钢板固定的作用是外科医生和病人之间讨论的问题，这在很大程度上取决于病人的功能要求和对运动、活动和离开这些活动的时间的期望。
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