A 48-Year-Old Female Who ‘Rolled’ Her Ankle

Differential Diagnosis

• Ankle dislocation without fracture
• Distal fibula fracture
• Metatarsalgia
• Proximal fifth metatarsal fracture

Diagnosis

This patient experienced fractures of both the distal fibula and the proximal fifth metatarsal.

Learnings/What to Look for

• The image on the left shows a closed fracture of the distal fibula
• The image on the right shows a transverse proximal fifth metatarsal shaft fracture; this is an unstable injury (also known as a Jones fracture)

Pearls for Urgent Care Management and Considerations for Transfer

• Malunion is common in Jones fractures; immediate follow-up with an orthopedist is indicated. Fractures through the tuberosity of the proximal fifth metatarsal that do not involve the shaft are stable fractures (pseudo-Jones) and can be treated with a post-op shoe
• Distal fibula fractures may or may not require surgery, per orthopedic follow-up. Immediate care in the urgent care setting amounts to ice, elevation, pain control, and crutches. The patient should remain non─weight-bearing until expedited follow-up with an orthopedist