Ortho Case of the Week – Foot ANSWERS
You can do this guys, don’t get de-feeted…
Case 1: A 35-year-old male presents for left lateral foot pain after tripping.
1. What is the diagnosis based on the x-ray above?
This is a pseudo-Jones fracture. There is a transverse complete fracture in the base of proximal fifth metatarsal bone reaching the articular surface.
Case 2: A 27-year-old female presents with left lateral foot pain after a fall.
2. What is the diagnosis based on the x-ray above?
This is a Jones fracture. There is a fracture of the proximal 5th metatarsal which is approximately 2 cm from the tarsometatarsal junction, and does not involve the articular surface.
3. How does treatment vary between these two conditions?
Pseudo-Jones fractures have a good prognosis and are usually treated non-operatively. If non displaced, these patients can be placed in a walking boot with WBAT and PCM follow-up. If displaced, refer to ortho for follow-up.
Jones fractures are often treated operatively, as they are prone to non-union (up 30 to 50%). Displacement can increase with weight-bearing, so they need to be splinted in the ER with a posterior short leg splint (video), NWB, and follow-up with ortho in 3 to 5 days.
4. What is the treatment for nonfifth metatarsal fractures?
Posterior short leg splint (described above).
Case 3: A 40-year-old male complaints of right foot pain after an MVC.
5. What is the can’t-miss diagnosis based on the x-ray above?
This is a Lisfranc injury. There is a widened second tarsometatarsal joint.If x-rays are negative but you have a high clinical suspicion for this injury, you can also:
- Obtain weight bearing views
- Compare to the contralateral side
- Obtain advanced imaging or MRI
- Treat presumptively with a posterior short leg splint and NWB with orthopedics follow-up
Resources:
https://wikem.org/wiki/Posterior_ankle_splint
https://wikem.org/wiki/Lisfranc_injury
https://wikem.org/wiki/Foot_and_toe_fractures
https://radiopaedia.org/cases/lisfranc-injury-7?lang=us
https://radiopaedia.org/cases/jones-fracture-4?lang=us
https://radiopaedia.org/cases/pseudo-jones-fracture-5?lang=us