Brian A Howard was so kind as to annotate the scans I posted.
I think I overlooked definite metaphyseal fractures at the 3rd metatarsal,
possibly also at the 4th metatarsal, just like Brian helpfully pointed out.
I find his comment on clinical assessment also worth remembering. After all
it´s a 4 year old patient we´re talking about…
Thanks again everyone!
Andrei
———- Forwarded message ———
[image: Screen Shot 2021-09-20 at 11.28.18 AM.png]
Was wondering what the arrows point to. Know of gymnastic wrists physeal
remodelling but not read of MT remodelling from mechanical overuse.
Clinical rule of treat the patient not the xray has two sides, often
clinicians ignore that we see that is not painful. Have a great day. BAH
On Mon, Sep 20, 2021 at 4:32 AM Andrei Dumitrescu <xisquare@gmail.com>
wrote:
>
> Thank you all for your replies.
>
> Most responders seem to think that there is just immature ossification
> giving that irregular bone appearance.
> (Normal vs. fracture 8:2)
> The surgeons have decided to put the boy’s foot in a cast for a week and
> then re-assess clinically.
> Sometimes I guess symptoms are more important than pictures 😉
>
> Thanks again, and have a good week!
>
> Andrei
>
>
> On Fri, 17 Sept 2021 at 09:10, Andrei Dumitrescu <xisquare@gmail.com>
> wrote:
>
>>
>> 4.5 year old boy, fell from a swing, pain in the left foot
>>
>> Suspected midfoot fractures. There are some irregularities at the base of
>> the proximal metatarsals.
>>
>> I think that’s just immature ossification, normal for his age.
>>
>> What is your opinion?
>>
>> Cheers,
>>
>> Andrei
>>
>> —
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