Presentation
Mechanical fall and twisted right ankle; unable to weight bear.
Patient Data
There is malalignment of of the tarsometatarsal joints, in particular there is widening between the bases of the first and second metatarsals and the second metatarsal is shifted laterally - these findings are highly concerning for a Lisfranc injury. Small bony fragment at the medial base of the first metatarsal is likely a fracture fragment. There is also a fracture of the base of the fourth metatarsal.
The distal tibia, fibula and hindfoot are intact. The navicular and cuboid bone are intact.
There are multiple fractures at the tarsometatarsal articulations of the first, second, third and fourth rays. The superolateral part of the medial cuneiform demonstrates an undisplaced fracture .The first metatarsal is intact. There is an undisplaced fracture through the proximal second metatarsal. The middlecuneiform appears intact. A similar injury is shown through the proximal end of the third metatarsal. The lateral cuneiform appears intact. There is a similar injury to the proximal end of the fourth metatarsal. The cuboid and fifth metatarsal appear intact. An os tibiale externum is noted. More distally the metatarsals and toes are intact.
Case Discussion
This injury represents a homolateral Lisfranc fracture-dislocation.
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