You appear to be using an old web browser that may not properly display our pages. Our sites are built using standards compliant guidelines that require a more recent web browser such as:

Internet Explorer 6+
FireFox 1+
Netscape 6+

Case of the Month 11/09

Q1: This 22-year-old male presented to the ED complaining of pain and swelling to the right foot and inability to bear weight. He had been in a motor vehicle accident in which he was rear-ended by another car and slammed his right foot onto the break.

What's wrong with this picture? (hint – this type of injury has a specific eponym)

View answer

A1:

There is a Lisfranc fracture and dislocation. The Lisfranc joint (circled) is made up of the articulations between the first three metatarsals and the three cuneiforms as well as the fourth and fifth metatarsals with the cuboid. Findings suggestive of a Lisfranc injury include widening between the first and second or second and third metatarsal and/or a fracture of the bones which make up the Lisfranc joint. In this example, there is clear widening of the space between the second and third metatarsal as well as a fracture of the medial cuneiform. There is also a subtle fracture at the lateral edge of the cuboid.

Q2:

Can you name all of the bones of the midfoot on the image below? (try before reading the answer to question 1)

View answer

A2:

Conclusion. This patient underwent ORIF (see below) and was discharged in stable condition four days after admission. He was advised to only bear weight on the heel of that foot on discharge