A 2-Year-Old with Foot Pain After Jumping Off a Bed

Differential Diagnosis

• Salter type II fracture
• Cuboid fracture
• Navicular compression fracture
• Compartment syndrome

Diagnosis

The x-ray reveals an acute Salter type II fracture at the base of the first metatarsal, with soft tissue swelling in the midfoot. This injury is also known as a bunk bed fracture, and is a common fracture in  children. It is a pediatric variant of the adult Lisfranc injury.

Learnings/What to Look for

• This injury occurs in children between the ages of 3 to 6 years
• The fracture is often associated with jumping or falling injury from the bunk bed (or similar mechanism), with the child landing on a plantar flexed foot with axial loading
• The flexion force wedges the first cuneiform and first metatarsal bone epiphysis in to the first and second metatarsal interspace
• The oblique articular surface of the first cuneiform bone facilitates the lateral displacement and wedging leading to a Salter type II fracture of the base of the first metatarsal bone
• The fracture subluxations of second and more lateral tarsometatarsal joints in more significant injury may occur with plantar displacement of the metatarsal bones

Pearls for Urgent Care Management and Considerations for Transfer

• Injuries limited to a nondisplaced fracture of the base of the first metatarsal bone are managed conservatively with immobilization and pain management
• More complex injuries involving tarsometatarsal joints are usually treated surgically with closed or open reduction, internal fixation and immobilization

 

Acknowledgment: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).