Log in Sign up
Cart

SplintER Series: En Pointe

Posted by Ko, MD, CAQ-SM on

A 32-year-old female presents to the emergency department with right foot pain after rolling her ankle during dance class. On exam, there is mild swelling and tenderness over the 5th metatarsal. The above x-ray was obtained (Figure 1: Case courtesy of Dr. Henry Knipe, Radiopaedia.org, rID: 28104).

What is your diagnosis?

The patient is diagnosed with a dancer’s fracture, a spiral or oblique fracture of the distal 5th metatarsal.

  • Pearl: This fracture can occur even with a low energy mechanism of injury and is more commonly seen in the female population [1].

What is the mechanism of injury? How do patients present?

Patients may describe a mechanism where they roll over their foot or land after a jump. Often there is a reported “twisting” injury [2]. On exam, patients have swelling, tenderness, and sometimes ecchymosis over the 5th metatarsal shaft.

  • Pearl: Be careful not to confuse this with a Jones fracture (proximal 5th metatarsal fracture) or a metatarsal stress injury, as management varies.

How is it diagnosed?

A Dancer’s fracture is diagnosed with x-ray imaging (Figure 1). Most commonly, the fracture line extends from the lateral metatarsal distally and then travels medially at the more proximal end [1].

Figure 1: Case courtesy of Dr. Henry Knipe, Radiopaedia.org, rID: 28104.

What is your management in the ED? What is your disposition?

Dancer’s fractures are usually managed non-operatively [3]. In the ED, patients should be placed in a walking CAM boot or post-operative shoe. Patients can weight-bear as tolerated and can be discharged with sports medicine or orthopedic follow-up.

  • Pearl: These fractures take approximately 6-8 weeks to heal. In severely displaced or nonunion cases, surgery may be required [3].

Resources & References:

Check out ALiEM’s Paucis Verbis cards to brush up on other can’t miss orthopedic injuries, and SplintER Series or EMrad for more cases.

  1. Schwagten K, Gill J, Thorisdottir V. Epidemiology of dancers fracture. Foot and Ankle Surgery. 2021;27(6):677-680. PMID: 33229215.
  2. Smidt KP, Massey P. 5th Metatarsal Fracture. In: StatPearls. StatPearls Publishing; 2022. Accessed September 17, 2022. http://www.ncbi.nlm.nih.gov/books/NBK544369/
  3. Morgan C, Abbasian A. Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature. Foot (Edinb). 2020;43:101654. PMID: 32086137.

Author information

Ko, MD, CAQ-SM

Assistant Professor
Department of Emergency Medicine
New York Presbyterian-Weill Cornell Medical Center

|

The post SplintER Series: En Pointe appeared first on ALiEM.

Go to full site