Case Study

Fractures can be seen on ultrasound. Part 1

September 22, 2020

A fractured fifth metatarsal, but nothing seen on x-ray.


A 24-year-old woman was referred for ultrasound, having rolled her right ankle playing netball.  The injury had occurred approximately two months prior to referral, but the right ankle was still swollen, had a decreased range of motion, and was painful when tested with active-resisted movements. Ultrasound examination (Philips iU22, L12-5 MHz and 15-7 MHz Hockey Stick transducers) of the right ankle and foot were performed.
The examination indicated: “Foot: fifth metatarsal base non-displaced fracture and fourth TMT joint partial ligament tear Grade 2 injury. Ankle ATFL partial tear Grade 2 injury and CFL sprain Grade 1 injury.”


Key findings (Figures A-F) included:


“The fifth metatarsal base has a cortical bone defect at the peroneus brevis tendon insertion. The tendon is mildly thickened and is reduced echogenic. No tear or vascularity. This region is tender.
The fourth tarsometatarsal joint capsule dorsal aspect cuboid attachment is thickened and has an intrasubstance tear. This region is tender.
The anterior talofibular ligament is thickened, is heterogeneous, has increased vascularity, and a partial tear (5 x 5 mm).
The calcaneofibular ligament is thickened (5 mm) and is reduced echogenic. No tear.”


Coming in the next post:

We have presented cases with fracture findings previously but not focussed on the fracture, instead promising to come back to them later.


This post is the first instalment of us making good on that promise.


Expect a discussion of ultrasound diagnosis of fractures next time.


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Phone: 09 815 0656‬

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