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Radiology Image: A 43-year-old male

A 43-year-old male

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Patient data
  • Age: 43
  • Gender: Male
  • Medical history: Blank
  • Initial presentation: Missed a stairstep, unable to put pressure on right foot immediately after the event. Dorsal haematoma on right foot. Pain on palpation at metatarsal 1 to 4, axial pressure pain on the hallux.

X-ray of the foot

X-ray of the foot

X-ray of the foot

X-ray of the foot

[WpProQuiz 11]

S. Spijkers, R. Hemke & M. Maas

Checklist Röntgen (Foot)

Medial aspect (DP)

  • 1st and 2nd metatarsals, check alignment and fractures
  • Check the medial and intermediate cuneiform for fractures and/or dislocations

Lateral aspect (oblique)

    • 3rd, 4th and 5th metatarsals, check alignment and fractures
    • Check lateral cuneiform for fractures and/or dislocations
    • Navicular and cuboid, check for fractures
    • Medial borders of 3rd metatarsal and lateral cuneiform should line up

Bone review

  • Check around the cortex of every bone
    • start proximally and work distally, medial to lateral
    • check any tarsal coalition
  • Look for any bone that isn’t attached
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A Lisfranc fracture as seen in this patient almost always is a direct consequence of a high kinetic energy impact. A fracture such as this mostly occurs in traffic accidents, industrial work, or other environments where large-momentum impacts are possible. In this patient the impact seems relatively weak, where only one stairstep is missed. Still, taking into account the unbearable pain when pressure is put on the foot of the patient, a Lisfranc injury must be considered. An x-ray is almost always concluding on diagnosing a Lisfranc injury. In this case, a CT scan was made to investigate the extend of the dislocation and to look for any other possible fractures.

Usually when the dislocation is relatively small, (<2 mm), external fixation through plaster and six weeks without pressure on the foot will be the treatment plan. However, if the dislocation is larger than 2 mm internal fixation by a temporary screw or K-wire will be needed. The patient is not allowed to put any pressure on his or her foot for at least six weeks.

X-ray of the foot with Lisfranc facture

X-ray of the foot with Lisfranc facture

  1. Jones, J. (2016). Foot radiograph (an approach) | Radiology Reference Article | Radiopaedia.org. Radiopaedia.org. Retrieved 28 April 2016, Available here
  2. Lisfranc Fracture Dislocation: Background, Anatomy, Pathophysiology. (2016).Emedicine.medscape.com. Retrieved 28 April 2016, Available here
  3. Trauma X-ray – Lower limb – Foot. (2016). Radiologymasterclass.co.uk. Retrieved 28 April 2016, Available here
  4. Weir, J. & Abrahams, P. (2011). Imaging atlas of human anatomy. Mosby Elsevier.

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