Resolution
In this case, the x-ray was directed to the ankle die to the nature of the patient’s complaint, but the pathology was in the foot. This is a proximal fifth metatarsal fracture involving the tuberosity.
It is difficult to assess on their view whether or not there is involvement of the diaphysis. Distinguishing fifth metatarsal “shaft” fractures from tuberosity fractures is critical to determining stability. Fifth metatarsal shaft fractures have a high incidence of malunion, and orthopedic consolation is mandatory. Tuberosity fractures can be managed with a compression dressing and a post-op shoe.
This case highlights the importance of ensuring appropriate films are obtained based on mechanism of injury and exam. It also demonstrates that pathology can be elsewhere from the location of the primary complaint and findings.
Many urgent care patients are triaged to x-ray prior to physician evaluation. A full set of foot films would be indicated in this case.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
