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Resolution
The x-rays reveal fractures of both the distal fibula and proximal fifth metatarsal. A cast splint was applied and the patient was instructed to follow up with an orthopedist.
More specifically, the film on the left shows a transverse proximal fifth metatarsal shaft fracture; this is an unstable injury (Jones fracture). Malunion is common, and orthopedic follow-up is urgent.
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.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
Clinical Challenge: July/August, 2010
Nahum Kovalski, BSc, MDCM
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