WIDI - Case344-Stress Fracture Second Metatarsal

Case Notes

History

30 year old male with left mid foot pain.

Exam

3 views left foot

Prior Study

None

Technique	Correct Answer	Your Answer
The exam is over or under penetrated.	No	NA
The exam is limited by overlying structures or soft tissues, body habitus, patient positioning, support devices, or motion.	No	NA
The area of concern is indicated by the patient, technologist, or provider.	Yes	NA
The area of concern is included on the exam.	Yes	NA

Technique

Correct Answer

Your Answer

The exam is over or under penetrated.

The exam is limited by overlying structures or soft tissues, body habitus, patient positioning, support devices, or motion.

The area of concern is indicated by the patient, technologist, or provider.

Yes

The area of concern is included on the exam.

Yes

Soft Tissues	Correct Answer	Your Answer
There is soft tissue swelling, indistinctness of fat/muscle planes, gas, or laceration in the area of clinical concern.	Yes	NA
There is an effusion, fat pad displacement, or fat fluid level.	No	NA
There is a radiodense or lucent foreign body.	No	NA
There are other densities, calcifications, post-surgical changes, or support devices in the soft tissues.	No	NA

Soft Tissues

Correct Answer

Your Answer

There is soft tissue swelling, indistinctness of fat/muscle planes, gas, or laceration in the area of clinical concern.

Yes

There is an effusion, fat pad displacement, or fat fluid level.

There is a radiodense or lucent foreign body.

There are other densities, calcifications, post-surgical changes, or support devices in the soft tissues.

Bone	Correct Answer	Your Answer
There is a break or interruption of the continuity of the cortical or cancellous bone with or without displacement of a fracture fragment.	Yes	NA
There is abnormal angulation of the cortical surface relative to the normal cortex.	Yes	NA
There is linear or irregular lucency, or increased density, cortical depression, flattening, or collapse with or without cortical disruption or thickening, which may be from a compression or impaction fracture, stress or insufficiency fracture, osteonecrosis, or other fracture.	Yes	NA
There is disruption of commonly recognized anatomical lines (e.g. iliopectineal) or structures (e.g. sacral foraminal or arcuate lines).	No	NA
There is a displaced fragment which may be from avulsion by a tendon, or joint capsule or from a comminuted or other fracture.	No	NA
There is periosteal or endosteal reaction which could indicate a healing or subacute fracture or other abnormality.	No	NA
The stress trabeculae or other trabeculae of the cancellous bone are interrupted or otherwise abnormal.	No	NA
There is subchondral abnormality (lucencies, increased density, erosion) with or without cortical disruption or thickening which may be from osteonecrosis, osteochondritis dissecans, osteochondral fracture, inflammation, infection, or other abnormality.	No	NA
There is/are focal or multifocal lytic/lucent, blastic/sclerotic or mixed density lesion(s) or other abnormality.	No	NA
Overall bone density is increased or decreased.	No	NA

Bone

Correct Answer

Your Answer

There is a break or interruption of the continuity of the cortical or cancellous bone with or without displacement of a fracture fragment.

Yes

There is abnormal angulation of the cortical surface relative to the normal cortex.

Yes

There is linear or irregular lucency, or increased density, cortical depression, flattening, or collapse with or without cortical disruption or thickening, which may be from a compression or impaction fracture, stress or insufficiency fracture, osteonecrosis, or other fracture.

Yes

There is disruption of commonly recognized anatomical lines (e.g. iliopectineal) or structures (e.g. sacral foraminal or arcuate lines).

There is a displaced fragment which may be from avulsion by a tendon, or joint capsule or from a comminuted or other fracture.

There is periosteal or endosteal reaction which could indicate a healing or subacute fracture or other abnormality.

The stress trabeculae or other trabeculae of the cancellous bone are interrupted or otherwise abnormal.

There is subchondral abnormality (lucencies, increased density, erosion) with or without cortical disruption or thickening which may be from osteonecrosis, osteochondritis dissecans, osteochondral fracture, inflammation, infection, or other abnormality.

There is/are focal or multifocal lytic/lucent, blastic/sclerotic or mixed density lesion(s) or other abnormality.

Overall bone density is increased or decreased.

Joints and Alignment	Correct Answer	Your Answer
There is an effusion, fat pad displacement, or fat fluid level.	No	NA
There is an intra-articular loose body or chondrocalcinosis.	No	NA
The joint is widened, narrowed, dislocated, malaligned, or incongruent.	No	NA
The subchondral or intra-capsular bone is fractured, interrupted, flattened, compressed, impacted, or otherwise abnormal.	No	NA
There is increased, decreased, or mixed density in subchondral bone.	No	NA

Joints and Alignment

Correct Answer

Your Answer

There is an effusion, fat pad displacement, or fat fluid level.

There is an intra-articular loose body or chondrocalcinosis.

The joint is widened, narrowed, dislocated, malaligned, or incongruent.

The subchondral or intra-capsular bone is fractured, interrupted, flattened, compressed, impacted, or otherwise abnormal.

There is increased, decreased, or mixed density in subchondral bone.

Other Findings	Correct Answer	Your Answer
There are degenerative changes, developmental changes or other anatomic variants, or other existing conditions that may or may not be contributing to symptoms which can or should be further evaluated non-emergently or are otherwise incidental.	Yes	NA
The remainder of the exam is abnormal for age.	No	NA

Other Findings

Correct Answer

Your Answer

There are degenerative changes, developmental changes or other anatomic variants, or other existing conditions that may or may not be contributing to symptoms which can or should be further evaluated non-emergently or are otherwise incidental.

Yes

The remainder of the exam is abnormal for age.

Impression

Expert Answer

Nondisplaced healing left fifth metatarsal stress fracture.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Verbal communication to the ED physician of a healing stress fracture of the fifth metatarsal.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer

Section 2 Case344

Findings Results

You scored: 0 / 25

Technique	Correct Answer	Your Answer
The exam is not over or under penetrated.	No	NA
The exam is not limited by overlying structures or soft tissues, body habitus, patient positioning, support devices, or motion.	No	NA
The area of concern is indicated by the patient.	Yes	NA
The area of concern is included on the exam.	Yes	NA

Soft Tissues	Correct Answer	Your Answer
There is mild soft tissue swelling.	Yes	NA
There is no fat pad disruption or displacement.	No	NA
There is no radiodense or lucent foreign body.	No	NA
There are no other densities or calcifications in the soft tissues.	No	NA

Bone	Correct Answer	Your Answer
There is a break or interruption of the continuity of the cortical bone of the proximal lateral fifth metatarsal metaphysis.	Yes	NA
There is abnormal angulation of the cortical surface relative to the normal cortex of the fifth proximal lateral metatarsal metaphysis which is thickened.	Yes	NA
There is linear lucency and cortical thickening of the proximal lateral fifth metatarsal metaphysis from a healing stress fracture. There is some cortical thickening of the shafts of the second, third, and fourth metatarsals but no cortical defect.	Yes	NA
There is no disruption of commonly recognized anatomical lines (e.g. ilio-pectineal) or structures (e.g. sacral foraminal or arcuate lines).	No	NA
There is not a displaced fragment which may be from avulsion by a tendon, ligament, or joint capsule or from a comminuted or other fracture.	No	NA
There is no periosteal or endosteal reaction which could indicate a healing or subacute fracture or other abnormality.	No	NA
The trabeculae of the cancellous bone are normal.	No	NA
There is no subchondral abnormality (lucencies, increased density, erosion) with or without cortical disruption or thickening which may be from osteonecrosis, osteochondritis dissecans, osteochondral fracture, inflammation, infection, or other abnormality.	No	NA
There are no focal or multifocal lytic, lucent, blastic, sclerotic, or mixed density lesions.	No	NA
Overall bone density is not increased or decreased.	No	NA

Joints and Alignment	Correct Answer	Your Answer
There is no effusion, fat pad displacement, or fat fluid level.	No	NA
There is no intra-articular loose body or chondrocalcinosis.	No	NA
The joint is not widened, narrowed, dislocated, malaligned, or incongruent.	No	NA
The subchondral or intra-capsular bone is not fractured, interrupted, flattened, compressed, impacted, or otherwise abnormal.	No	NA
There is no increased, decreased, or mixed density in subchondral bone.	No	NA

Other Findings	Correct Answer	Your Answer
There are degenerative changes with plantar calcaneal enthesophytes.	Yes	NA
The remainder of the exam is not abnormal for age.	No	NA

Stress Fracture Second Metatarsal

Case Images

Case Notes

History

Exam

Prior Study

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Findings

Impression

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Recommendations & Acuity

Recommendations

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Acuity

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Review Findings Results

Findings Results

Case Images

Case Notes

History

Exam

Prior Study

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Impression

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Recommendations & Acuity

Recommendations

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Acuity

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