Abstract
Intro :
This case involves a young patient presenting with concern for hallux fracture following a traumatic fall and increased pain, however, follow up imaging is more indicative of a congenital anatomic variant rather than an acute fracture. This case highlights the importance of accurate radiologic interpretation and clinical correlation to prevent unnecessary interventions. Background:
There is an important differentiation between an anatomical variant and a malformation or abnormality. Modern day clinicians term anatomic variants as deviations from the “normal” arrangement of anatomical structure without causing significant impairment of function. Pathological abnormality on the other hand results in impairment of function.
Case Presentation :
A 10 year old patient presents to clinic endorsing significant left toe pain following a parkour injury two days prior. The patient stubbed his toe and tripped, noting immediate pain and swelling following the incident that have not been adequately controlled with over the counter medication. He is unable to ambulate without great discomfort. Due to the concern for fracture, X-ray of the left foot is ordered. The initial reading was significant for “cleft-like and linear lucency” with “fine sclerotic edge”. Acute fracture was not able to be ruled out, and the patient was diagnosed with nondisplaced fracture of the left phalanx, and was discharged home with a walking boot and activity restrictions. Upon follow up and re-evaluation 2 weeks later he was pain free, and repeat imaging was performed for comparison on bilateral feet with identical findings of morphology. With reference to literature, it was determined that the patient had an anatomic variant of the bilateral great toes and was discontinued from his boot and able to participate in activities as tolerated.
Conclusion :
This case highlights the importance of building foundational knowledge to differentiate anatomical variants from acute injuries, particularly in the developing pediatric patient. This understanding is relevant not only for proper diagnoses but also for preventing over-treatment and unnecessary patient burden within the pediatric population.
