Patient History
58 M with right midfoot pain
Findings
ARTICULATIONS:
Bone: Comminuted nondisplaced fracture of the medial cuneiform (C1) extending into the naviculocuneiform and tarsometatarsal surfaces.
Comminuted and displaced intraarticular fracture of the lateral cuboid surface extending to the calcaneocuboid, 4th and 5th tarsometatarsal joints.
Intraarticular nondisplaced chip fracture at the medial base of the 1st metatarsal base.
Oblique nondisplaced extraarticular fracture of the head and distal shaft of the 5th toe proximal phalanx.
Midfoot: Lateral displacements of the 2nd-5th metatarsal shaft with the 1st tarsometatarsal joint remaining congruent.
Lisfranc Joint: High-grade diastasis (1.2cm) of the C1-M2 interval and lateral divergence of the 2nd-5th metatarsal bases.
Forefoot: End-stage degenerative arthropathy of the great toe metatarsophalangeal joint with large osteophyte spurs, generalized chondral plate delamination with penetrating chondromalacia, small joint effusion, capsulitis, periarticular soft tissue swelling and chronic injury of the 1st plantar plate complex.
Severe osteoarthrosis and partial fusion of the metatarsosesamoid joints.
Lisfranc Ligament: Full rupture of the interosseous band of the Lisfranc ligament (C1-M2) as well as the dorsal and plantar components.
TENDONS:
Peroneus Longus/Brevis: Intact.
Posterior Tibialis: Intact.
Flexor Compartment: Intact.
Extensor Compartment: Intact.
Plantar Plate: 2nd-5th plantar plates are intact.
GENERAL:
Muscles: Traumatic edema throughout the intrinsic foot muscles. Grade 1 fatty infiltration and volumetric atrophy throughout.
Soft Tissue: Midfoot dorsal soft tissue swelling and subcutaneous edema.
Impressions
1. Homolateral Lisfranc injury with complete rupture of the interosseous band of the Lisfranc ligament, 1.2cm C1-M2 diastasis and lateral displacement of the 2nd-5th metatarsal bases. The small dorsal lisfranc ligament is also torn. The 1st tarsometatarsal joint remains congruent.
2. Comminuted nondisplaced fracture of the medial cuneiform (C1) extending into the naviculocuneiform and tarsometatarsal surfaces.
3. Comminuted and displaced intraarticular fracture of the lateral cuboid surface extending to the calcaneocuboid, 4th and 5th tarsometatarsal joints.
4. Oblique nondisplaced extraarticular fracture of the head and distal shaft of the 5th toe proximal phalanx.
5. End-stage degenerative arthropathy of the great toe metatarsophalangeal joint with large osteophyte spurs, penetrating chondromalacia, small joint effusion, capsulitis, periarticular soft tissue swelling and chronic injury of the 1st plantar plate complex. Severe osteoarthrosis and partial fusion of the metatarsosesamoid joints.
