SET T0022 -
Emergency Department

Fracture.

• The apophysis at the base of the 5th metatarsal (MT) is normal in position, orientation, and appearance. 
• The undisplaced fracture of the base of the 5th MT is identified by the faint line situated at right angles to the long axis of the MT. The fracture line is perhaps best shown on the oblique view in this patient. All the same, it is also visible on the AP radiograph.

Call the orthopaedic team.

A Lisfranc fracture dislocation is demonstrated (to be precisely accurate - it is a subluxation rather than a dislocation); at the 2nd tarso-metatarsal joint

If unrecognised and managed incorrectly, a Lisfranc injury can lead to significant disability and long term walking problems.

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 295-297,302-303

Faint periosteal reaction at the medial aspect of the shaft of the 2nd metatarsal.

Stress fracture.

This fracture involves the shaft of the 5th metatarsal (MT), rather than the base. This position of the fracture has an important connotation . . .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Page 301

Otherwise known as a Jones Fracture. The healing of a Jones fracture may prove to be be clinically problematical. Delayed union is a recognised complication.

(Note the appearance of the two sesamoid bones in relation to the great toe. Two examples of a common normal variant - neither is fractured).