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