ABSTRAK ABSTRACTFifth metatarsal bone fracture is one of the most commonest fractures of the foot. The decision for surgical or conservative approach is still inconclusive. Scoring system, decision analysis model and classification system are established to weigh between surgical and conservation approaches. Its unique anatomy and surgical complication influence decision on optimal surgical approach. Therefore, the present review attempts to look at factors that might influence decision making in management of fifth metatarsal fracture.

Patient: Female, 23-year-old Final Diagnosis: Tarlov cysts Symptoms: Low back pain Clinical Procedure: MRI • X-ray Specialty: Family Medicine • Orthopedics and Traumatology • Radiology Objective: Rare disease Background: Tarlov cysts are rare, with a prevalence of 3.3% in the Asian population, and symptomatic cases are even rarer. Here, we report a case of a young woman with multiple Tarlov cysts presenting in primary care with severe low back pain. Case Report: A 23-year-old Malay woman presented to a primary care clinic with sudden-onset, severe, and persistent low back pain for 1 week, affecting her activities of daily living (ADL), especially as a medical student, as she could not stand for more than 10 minutes. There were no other associated symptoms or recent trauma prior to the onset of back pain. Examinations revealed para-vertebrae muscle tenderness and restricted movements at the L4/L5 lumbosacral spine. A plain radiograph of the lumbosacral spine showed sclerosis and erosion of the right pedicle at the L4/L5 levels. Tuberculosis and haematological tests were normal. A lumbosacral MRI of the spine was ordered and the patient was urgently referred to the orthopaedic spine team. The MRI confirmed the diagnosis of multiple Tarlov cysts, with the dominant cyst located at the S2 level. Her symptoms and ADL improved with conservative management. She is being monitored closely by the orthopaedic team and primary care physician. Conclusions: This case highlights red flag symptoms, ie, sudden-onset, severe, and persistent low back pain, that warrant further investigation. Tarlov cysts should be considered as a differential diagnosis. Close monitoring is vital and early surgical intervention is indicated if symptoms worsen, to prevent potential irreversible nerve damage.