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 93-year-old female who lost her balance and twisted her ankle. She presents with significant pain in the ankle and swelling over her lateral ankle, though she is able to bear weight.

View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be.
Resolution of the case is described on the next page.

Clinical Challenge: December, 2009

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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