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HPI: The Patient is a 51-year-old female who arrived at the emergency room complaining of left foot pain for a duration of approximately one week. The patient stated that she stumbled off a curb while crossing the street and felt a sharp pain along the lateral boarder of her foot. The patient stated that she has attempted to reduce pain by “wrapping ankle” with an ace wrap, and stated that her pain was poorly controlled with oral NSAIDS.
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PMH: DM, HTN, Pterygium R eye
FMH: DM, Breast CA
SOCIAL: Pt denies ETOH, Tobacco, lives with her daughter, and works as a house keeper.
Allergies: NKDA
Medications: Glucophage, Coreg
VS: 97.2, HR 64, RR: 16, BP: 101/69
Physical Exam: The patient presents with palpable DP and PT pulses, each graded +2/4, and significant soft tissue swelling to the left foot which is non-pitting. There is tenderness to palpation noted to the dorsolateral aspect of the left foot, with pain of range of motion of the toes, especially the 4th and 5th digits of the left foot, additionally there is ecchymosis noted along the dorsum of the left foot. There are no skin lesions noted, and no breaks in the skin. The patient can bear weight to the extremity, but states that it is extremely painful.
Radiographic Results: Displaced oblique fracture of the 5th metatarsal of the left foot with shortening and angulations noted.
Click on the images below for a larger view. |
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| Fig. 1: Oblique distal shaft fracture of the 5th metatarsal |
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| Fig. 2: Fracture with shortening and displacement |
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| Fig. 3: Lateral view demonstrating mild plantar flexion of the distal fragment |
Considering the radiographs presented, history, and physical exam, how would you proceed with this case? Please reply with your thoughts and perspectives
and we will share them in a future issue of RI.
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