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Identify the fracture for provisinal dx

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Provisional Diagnosis - Right Foot Fracture

Patient: Master Faizan Shreiff, 12 years old Studies: Right Ankle AP/Lateral + Right Foot AP/Oblique (dated 20/07/2026)

Primary Finding

Right 3rd Metatarsal Shaft Fracture
  • Location: Mid-shaft to distal shaft/neck of the right 3rd metatarsal
  • Type: Complete, oblique/transverse fracture
  • Displacement: Significant lateral displacement of the distal fragment with overriding/shortening (the fragments have slipped past each other)
  • Associated soft tissue swelling over the dorsal forefoot at the fracture site

Ankle Films (IMG_3370)

The right ankle AP and lateral views show no obvious acute fracture of the distal tibia, fibula, talus, or calcaneus. The mortise appears intact. No significant talar tilt or widening of the ankle mortise.

Important Pediatric Notes

FindingInterpretation
Open physes at metatarsal heads and phalangeal basesNormal - skeletally immature (12 yr old)
Linear radiolucency at base of 5th metatarsalNormal apophysis - runs parallel to the shaft; NOT a fracture (Jones fracture / avulsion would be perpendicular)
Lisfranc alignmentAppears preserved

Provisional Diagnosis

Displaced fracture of the shaft of the right 3rd metatarsal (complete, oblique, with lateral displacement and shortening)

Immediate Management Considerations

  1. Non-weight bearing - strict, right foot
  2. Elevation + ice to reduce swelling
  3. Orthopedic review is already arranged (Ref: Dr. S. Abdhul Salam, MS Ortho, MRCS)
  4. Management decision will depend on degree of angulation/displacement on formal imaging:
    • Acceptable alignment - below-knee plaster cast, NWB, 4-6 weeks
    • Significant displacement (as here) - may require closed reduction +/- K-wire fixation to restore alignment and prevent malunion affecting gait
Note: This is an educational AI analysis to assist provisional assessment. Final interpretation and management must be confirmed by the treating orthopaedic surgeon with clinical correlation.

Ward notes provisional diagnosis how to write

Here is how to write a ward note with provisional diagnosis for this patient:

Ward Note Format

Date: 20/07/2026 Time: [e.g., 21:00 hrs] Ward: [Ward name/number]
Name: Master Faizan Shreiff Age/Sex: 12 years / Male IP No.: 34851 Ref by: Dr. S. Abdhul Salam, MBBS, MS (Ortho), MRCS

Presenting Complaint

Right foot pain and swelling following [mechanism - e.g., twisting injury / fall] since [duration].

History of Presenting Illness

Master Faizan Shreiff, 12-year-old male, presented with pain, swelling, and difficulty weight bearing on the right foot following [mechanism of injury] approximately [duration] ago. No open wound. No neurovascular complaints distally.

Examination

General: Conscious, oriented, afebrile, not in respiratory distress.
Local Examination - Right Foot:
  • Swelling + over dorsal forefoot, predominantly over 3rd metatarsal region
  • Tenderness + on palpation over 3rd metatarsal shaft
  • Restricted and painful weight bearing
  • Skin intact, no open wound
  • Distal CRT < 2 sec, sensation intact, toe movements possible but painful

Investigations

X-ray Right Foot AP/Oblique (20/07/2026):
  • Displaced fracture of the shaft of the right 3rd metatarsal - complete, oblique pattern with lateral displacement and shortening of distal fragment
  • No dislocation at Lisfranc joint
  • Open physes - appropriate for age
X-ray Right Ankle AP/Lateral (20/07/2026):
  • No fracture of distal tibia, fibula, talus, or calcaneus
  • Ankle mortise intact

Provisional Diagnosis

Displaced fracture of the shaft of right 3rd metatarsal (closed)

Plan

  1. Strict non-weight bearing - right lower limb
  2. Limb elevation
  3. Ice pack application (wrapped, not direct)
  4. Analgesics: Tab. Paracetamol [dose as per weight] TID / PRN
  5. Below-knee posterior slab immobilization - right side
  6. Orthopedic review for decision on closed reduction vs. K-wire fixation
  7. Pre-op workup if surgical intervention planned (CBC, RFT, blood group, coagulation profile)
  8. Informed consent to be obtained (parent/guardian)
  9. Review after orthopaedic assessment
Signature: __________________ Name & Designation: __________________ Contact No.: __________________

Key Tips for Writing the Provisional Dx Line

SituationHow to Write
Fracture confirmed on X-ray"Displaced fracture of shaft of right 3rd metatarsal (closed)"
If mechanism is unknownAdd "(? following trauma)"
If surgical neededAdd "- for closed reduction +/- K-wire fixation"
If still awaiting imaging"? Fracture right 3rd metatarsal - pending X-ray"
The word "provisional" means you are not yet 100% committed - it signals the diagnosis is based on current findings and may be revised after specialist review, further imaging, or intraoperative findings.
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