Ankle and Foot 47 - Department of Radiology - University of ...
Ankle and Foot 47 - Department of Radiology - University of ... Ankle and Foot 47 - Department of Radiology - University of ...
2270 VII Imaging of the Musculoskeletal System C A D B Figure 47-80. Bilateral calcaneal fractures in a 25-year-old who fell from a three-story parking garage, landing feet first. Lateral radiographs of the left (A) and right (B) ankles were obtained. In the left ankle, lucent fracture lines are clearly seen (arrowheads). In the right ankle, Böhler’s angle is flattened (compare with part N, after open reduction and internal fixation [ORIF]). As part of the trauma workup, a CT scan of the abdomen and pelvis was performed, hence the presence of oral contrast in the colon on the anteroposterior scout image (C). Because of the mechanism causing bilateral calcaneal fractures, it was necessary to evaluate the lumbar spine for fractures. The same raw data from the large field-of-view (FOV) scan of the abdomen and pelvis were reconstructed into thin, overlapping, small FOV images centered on the lumbar spine as source images (D). The arrowheads point to a fracture through the anterosuperior end plate of L1. E, Sagittal reformatted CT image of the lumbar spine shows the thin fracture through the anterosuperior corner of L1 (arrowhead). F and G, MR sagittal T1- and proton-density–weighted images do not well demonstrate the L1 fracture. E F G Ch047-A05375.indd 2270 9/9/2008 5:35:13 PM
47 Ankle and Foot 2271 47 H J I LPT Figure 47-80, cont’d H and I, MR sagittal and coronal fatsuppressed T2-weighted images show bone marrow edema throughout the superior halves of the L1 and L2 vertebral bodies. The next day, a CT scan was performed through both ankles simultaneously and reformatted in multiple planes for each ankle individually using our hindfoot protocol. Displayed are images of the right calcaneus. J, Sagittal image through the lateral process of the talus (LPT). The calcaneus is fractured just below the LPT, where the wedge-shaped LPT was driven into the calcaneus at the angle of Gissane. The small back spots with the fractured calcaneus are air, indicating that this was an open fracture that was subsequently reduced. Coronal oblique images through the posterior (K) and middle (L) facets of the subtalar joint were obtained. These calcaneal fractures typically begin with impaction from the LPT, and there is extension into the posterior facet (white arrowhead). In this patient, the fracture also extends through the sustentaculum tali (ST) into the middle facet (black arrowhead). Continued M-STJ LPT P-STJ ST K L Ch047-A05375.indd 2271 9/9/2008 5:35:15 PM
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<strong>47</strong> <strong>Ankle</strong> <strong>and</strong> <strong>Foot</strong> 2271 <strong>47</strong><br />
H<br />
J<br />
I<br />
LPT<br />
Figure <strong>47</strong>-80, cont’d H <strong>and</strong> I,<br />
MR sagittal <strong>and</strong> coronal fatsuppressed<br />
T2-weighted images<br />
show bone marrow edema<br />
throughout the superior halves <strong>of</strong><br />
the L1 <strong>and</strong> L2 vertebral bodies.<br />
The next day, a CT scan was<br />
performed through both ankles<br />
simultaneously <strong>and</strong> reformatted in<br />
multiple planes for each ankle<br />
individually using our hindfoot<br />
protocol. Displayed are images <strong>of</strong><br />
the right calcaneus. J, Sagittal<br />
image through the lateral process<br />
<strong>of</strong> the talus (LPT). The calcaneus is<br />
fractured just below the LPT,<br />
where the wedge-shaped LPT was<br />
driven into the calcaneus at the<br />
angle <strong>of</strong> Gissane. The small back<br />
spots with the fractured calcaneus<br />
are air, indicating that this was<br />
an open fracture that was<br />
subsequently reduced. Coronal<br />
oblique images through the<br />
posterior (K) <strong>and</strong> middle (L) facets<br />
<strong>of</strong> the subtalar joint were obtained.<br />
These calcaneal fractures typically<br />
begin with impaction from the LPT,<br />
<strong>and</strong> there is extension into the<br />
posterior facet (white arrowhead).<br />
In this patient, the fracture also<br />
extends through the sustentaculum<br />
tali (ST) into the middle facet<br />
(black arrowhead).<br />
Continued<br />
M-STJ<br />
LPT<br />
P-STJ<br />
ST<br />
K<br />
L<br />
Ch0<strong>47</strong>-A05375.indd 2271<br />
9/9/2008 5:35:15 PM
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