Foot fractures


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Foot fractures

  1. 1. Image Bank: Foot Fractures<br />Image and Answer<br />
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  3. 3. 1st and 2nd phalangeal fractures, note the lucency and cortical disruption<br />
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  5. 5. No fracture, this is a growth plate in a child, note the lack of cortication of the fragment and the multiple ossification centers, indicating this is a young foot. <br />
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  7. 7. Inverting the image sometimes reveals a subtle fracture, as seen at the base of the 5th metatarsal<br />
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  10. 10. +Calcaneal fracture, always track your cortical lines for disruptions<br />
  11. 11. Dedicated calcaneus film, consider this in pt’s w/ falls or significant heel injuries concerning for a fracture. Mild hyperlucency noted (red arrow, likely calcific Achille’s tendon insertion) and hypolucency (blue arrow) concerning for a subtle fracture.<br />
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  13. 13. Cuboid fracture, very subtle, easily overlooked<br />
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  15. 15. Subtle cuboid fracture vsosnaviculare, consider possibility of an avulsion injury 2/2 rupture calcaneocuboid part of the bifurcated ligament should mechanism exist<br />
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  17. 17. Cuboid fracture, longitudinal plantar ligament avulsion fx<br /><ul><li>Tx: NWB splint w/ ortho f/u 2wks for wt-bearing XRays</li></li></ul><li>
  18. 18. Cuboid fracture, note the hypolucent irregularity (green arrows) with cortical distortion (red arrow)<br /><ul><li>Tx: NWB short leg cast x4-6wks</li></li></ul><li>
  19. 19. Navicularpseudofracture…this is actually a normal Xray, the hypolucency is actually just as a result of prominent trabeculae, note the smooth cortical rim<br />
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  21. 21. Cuboid Fracture: Use the lateral films to interrogate the plantar aspect of the cuboid, you can easily miss obvious fractures!<br />
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  23. 23. Stress Fx/Jones Fx (distal to the insertion of the peroneus brevis and 4th MT groove) <br />Tx: Strict NWB ortho shoe 4-6wks vs possible ORIF (high risk of non-union, usually only indicated for displaced fx)<br />
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  25. 25. Jones Fx (Zone II), no displacement, so likely no surgery<br />
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  27. 27. Subtle Stress Fx (Jones Zone iII): Use the lateral films to also interrogate the 5th MT to scan for subtle cortical disruptions (red arrow)<br />
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  29. 29. Disrupted Jones III Fx: This will need pinning, not today, but soon…call ortho but send home<br />
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  31. 31. Avulsion PseudoJones (Zone II) fracture of the 5th MT<br />Unstable fracture, will require pinning, strict NWB status until f/u<br />
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  33. 33. LisFranc Fracture: Mechanism is twisting on a planted foot, falls, severe plantar flexion. Fracture through the proximal MTs or midfoot disruption causes classic “Terry Thomas” sign highlighted here. Isolated fracture type.<br />
  34. 34. (left) Lis Franc w/ marked MT disruption and homolateral (all 5 MTs) shift<br /><ul><li>Homolateral fracture type highly associated with cuboid fractures</li></ul>(below) Isolated LisFranc w/ subtle cortical disruptions noted<br />
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  36. 36. Multiple new (blue arrows) and a healing (red arrow) distal MT fractures in a child…should consider DCFS call if the story is in question<br />
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  38. 38. Proximal phalangeal fractures<br />Tx: Ice, elevation, NWB, f/u ortho for possible pinning given loose fragment<br />
  39. 39. A/P<br />Oblique<br />
  40. 40. Navicular fracture (blue arrows) with cuneiform fracture (red arrows). Navicularfxs have high incidence of avascular necrosis! Need ORIF!!!<br />