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Fifth metatarsal apophysis

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Tender over lateral foot after a sports injury. 5th metatarsal fracture?

Patient Data

Age: 13 years
Gender: Female
x-ray

No fracture or periosteal reaction.

The apophysis of the base of the 5th metatarsal is illustrated in keeping with the patient's bone age.

5 years earlier

x-ray

At the age of 8 years, the 5th metatarsal apophysis has not yet developed.

Case Discussion

A commonly mistaken fracture in pediatrics for the uninitiated.

This is the apophysis of the base of the 5th metatarsal.  It lies longitudinally oriented to the shaft, unlike a fracture.

When a red dot has been applied as the reporter it can be challenging to reverse it.  Good practice in these cases is to try to speak to the radiographer concerned about the perceived abnormality before a formal report is issued.

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