In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with.
If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]
The patient is a 2 ½-year-old who presents with pain in the left ankle after receiving a blow to the lower leg. You find he is unable to bear weight on that side.
View the image taken (Figure 1) and consider what your diagnosis and next steps would be.
Resolution of the case is described on the next page.
Resolution
The x-ray shows a fracture of the distal fibula and of the proximal fifth metatarsal.
This patient was placed in a cast splint. His parents were advised to follow up with an orthopedist.
As it happens, this was one of two cases on the same day at the same facility in which there were fractures of both of the fibula and metatarsal – a reminder that we always need to check both.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
These cases are among hundreds that can be found in Terem’s online x-ray Teaching File, with more being added daily. Free access to the file is available at: https://www2.teremi.com/xrayteach/. A no-cost, brief registration is required.
