van Dijk PA, Breuking S, Guss D, et al. - For managing Jones factures (JF), many advocate screw fixation to facilitate quicker ambulation and return to sport. Surgical outcomes may optimize with maximizing screw parameters based on fifth metatarsal (MT5) anatomy, alongside understanding the anatomic structures compromised by screw insertion. In this study, researchers sought to (1) associate the proximity of JF to the peroneus brevis (PB) and plantar fascia (PF) footprints and (2) determine optimal screw parameters given MT5 anatomy. On 21 cadaveric MT5s, 3D CT-scan reconstructions were performed, followed by meticulous mapping of the PB and PF onto the reconstructions. For each reconstruction, they modeled two traditional debated screw positions: (1) an anatomically positioned screw (AP), predicated on maximizing screw length by following the intramedullary canal (IMC) for as long as possible, and (2) a clinically achievable screw (CA), predicated on maximizing screw length without violating the fifth tarso-metatarsal joint or adjacent cuboid bone. Extension of the PB and PF into the JF site was observed in 29% and 43%, respectively. No effect of AP on PB and PF footprint was noted but it required screw entry through the cuboid and fifth tarso-metatarsal joint in all specimens. Avoiding the cuboid and fifth tarso-metatarsal joint, CA screw entry sites partly compromised the PB and PF insertions in 33% and 62% with a median surface loss of 1.6% and 0.81%, respectively. This study highlights the challenges linked with surrounding MT5 anatomy as they relate to optimal JF management. Based on observations, they recommend the CA screw position for reducing damage to surrounding structures, including the PB and PF footprint, while allowing a screw length approximately two thirds of the metatarsal length. This position enhances pull out strength while averting cortical penetration or inadvertent fracture site distraction.