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fracture distal 5th metatarsal head

Discussion in 'Pediatrics' started by Hoppo, Dec 8, 2011.

  1. Hoppo

    Hoppo Member


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    Had a 10 year old girl present with acute pain, limping into clinic. Shyly tells me "I kicked my brother and have been unable to walk on my (left) foot since."

    o/e the fifth met head is really really tender suspect a possible maybe # of some kind, bone burise at the very least - after some assessment and unable to get an X-Ray today decided to firbreglass cast - this had no effect on her ability to walk - removed the cast as she is still in pain - any ideas on further Tx

    have got her in an old jogger with the sides cut out and am reviewing her when x-ray's are carried out,

    any ideas anyone??? - last patient of the day and now i have a need for a headache any ideas wellcome many thanks Shaun
     
  2. Shaun,

    You cast her and took it off because it still hurt to walk during the same assessment ?

    If you suspect a fracture treat it as one till you can rule it out. ie Non-weightbearing at the least.

    Get some X-rays then re-assess would be how I would play it especially with growth plates possibly involved.

    I donĀ“t understand how a cast for 5 mins would reduce the pain if there was a fracture - but casting before x-ray maybe problematic

    Crutches - non weightbearing
    ice
    pain killers

    X- ray ASAP

    reassess would be how I would play it
     
  3. Hoppo

    Hoppo Member

    Thanks Mike, don't deal with fractures everyday, 5.05pm on a Friday so had to wait for X-Rays whick came back no #, advised no weight bearing - weird unable to touch her 5th met and now she is walking around ok on it? - sooky kid or quick recovery kid? Cheers
     
  4. Bug

    Bug Well-Known Member

    How fractures are treated in anyone really depends on the type and location and my best suggestion would be if you don't know how to treat one, don't. Refer it to the local ED, they will have the x-ray there and the equipment for immobilisation if required or to refer for surgery.

    A fibreglass casts have a multitude of risks, and using this as the first treatment on something you had no idea what it was, I don't think was the wisest move. It would never give instant pain relief and the ability to weight bear regardless of if it were a child or an adult. What if it had been a fracture requiring fixation and it had been delayed?

    I don't think this was either a sooky or quick recovery but a case where the diagnosis was unclear. Kids do stupid stuff and get hurt, sometimes because they haven't experience pain before their response is out of the ordinary. This is where we have to step up and understand the mechanism of the injury, what the injury could be, the most appropriate treatment method for the age and injury OR if you can't get rid of it to someone that can.

    I have have never lost the respect of another health professional by referring.
     
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