Case Author(s): Jerry Wallis , 6/17/94 . Rating: #D1, #Q4

Diagnosis: Metatarsal fracture

Brief history:

Dropped a steel drawer on her left foot 3 months ago. X-rays were negative (Upper row are immediate images and lower row are delayed images)


View main image(bs) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Metatarsal fracture


Mildly increase blood pool activity is seen (upper row) in the mid tarsal region near the tarsal-metatarsal junction, with markedly increased delayed uptake at the tarsal-metatarsal juction in the midfoot on the delayed images (lower row).

The increased uptake is somewhat difficult to localize, but is at the junction of the 2nd or 3rd metatarsals and the 2nd or 3rd cuneiform, most likely in the proximal 3rd metatarsal.


This appearance is typical for a fracture, which may be due to increased use or traumatic injury. Although less likely in this patient, healing avascular necrosis and focal osteomyelitis (e.g. due to a penetrating wound) could have a similar appearance.

On these 2 hour delay images, the limited uptake in the normal bones makes it difficult to localize the fracture precisely. If needed, pinhole images or delayed images at 24 hours would likely have defined the bony anatomy more precisely; however these were not done as clinical management would not have been affected.


Followup radiographs were negative, but the bone scintigraphy is sufficient for the diagnostis of fracture in this clinical setting.

Major teaching point(s):

Bone scintigraphy is more sensitive than plain radiography in detecting bone fractures.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Effect of Trauma)

Search for similar cases.

Edit this case

Add comments about this case

Read comments about this case

Return to the Teaching File home page.

Case number: bs003

Copyright by Wash U MO