PROBLEM
A 13-year-old boy arrives in your emergency department after stubbing his fifth toe. What conclusion can you reach based on this plain film of the digit?

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ANSWER
This “break” is actually a normal variation. The intermediate phalanx is divided into two separate, well-corticated ossification centers, indicating that they are not products of a fracture but rather a congenital anomaly.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 39(11):53-4, 2007