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avulsion fracture of the styloid process??

I have an eleven year old male who presented with pain at the styloid process following an inversion sprain. Xrays reported "no abnormality detected", however the film appeared to show an avulsion fracture of the styloid process. The "fracture" ran parallel with the 5th met, not angled toward the cuboid. It did not show a uniform separation, appearing to be still fixed to the shaft distally. Bilateral views revealed the contralateral foot to have the same appearance despite no history of injury. Is this a normal epiphyseal variation of what is an otherwise healthy 5th met?? Subsequent xrays reveal the non union still exists despite the patient being now assymptomatic. Is careful reintroduction to sport appropriate for this 11 year old??

 

Could possibly be an accessory bone at the 5th met base. Os vesalianum??

 

Sure its not an ossicle ?

http://www.chiroweb.com/archives/10/09/17.html

 

This condition is Iselin's disease (traction apophysitis of the peroneus brevis at the attachment to the 5th MT tuberosity), and is a similar condition to Sever's and Osgood-Schlatter's.

On x-ray the appearances will be suggestive of avulsion fracture, however in an active young male of 11 years of age, you can bet the house on it being Iselin's disease.

Rest, ice, immobilisation etc etc. Stable lace-up shoes and maybe a prefabricated orthotic usually suffice.

Google "Iselin's disease" to learn more. :)

LL