Ankle and Foot 47 - Department of Radiology - University of ...

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2278 VII Imaging of the Musculoskeletal System C A B D E Figure 47-86. Example of progression from normal to neuropathic Lisfranc dislocation. The patient was 49 years of age at presentation and had diabetes mellitus. Anteroposterior (A) and oblique (B) radiographs reveals normal anatomic alignment between the first (1), second (2), and third (3) cuneiforms and the first (I), second (II), and third (III) metatarsals, as well as between the cuboid (Cu) and the fourth (IV) and fifth (V) metatarsals. C, Lateral radiograph shows normal alignment between the midfoot and forefoot. Arterial calcifications (arrow) are present, consistent with the patient’s history of diabetes. The patient returned 2.5 years later. He had been having episodes of passing out and falling, although he did not remember these episodes well. He did not remember injuring himself, and because of peripheral neuropathy he had no sensation in his foot. He first noticed swelling and blisters on his foot the morning the following radiographs were taken. He ambulated normally without the assistance of a walker or cane. Anteroposterior (D) and oblique (E) radiographs illustrate a homolateral Lisfranc dislocation, with lateral dislocations of all five metatarsals. The first metatarsal (I) is not articulating with the first cuneiform (1) but is instead articulating with the second cuneiform (2). The base of the second metatarsal (II; arrowhead) is not articulating with anything. Ch047-A05375.indd 2278 9/9/2008 5:35:26 PM
47 Ankle and Foot 2279 47 F G H Figure 47-86, cont’d F, Lateral radiograph shows the dorsal dislocation of the second metatarsal (arrowhead). A CT scan was obtained to understand better the extent of the dislocation. G, Axial oblique scan shows that none of the metatarsals are articulating with their appropriate tarsals. In cases of complex fracture-dislocations, three-dimensional (3D) reformatted images can help in understanding the relative locations of the bones. H, This 3D image as viewed from above shows lateral displacement of all five metatarsals, and dorsal dislocation of the second through fourth metatarsals. Ch047-A05375.indd 2279 9/9/2008 5:35:28 PM
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Ken L. Schreibman Richard Bruce Ank
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Ankle and Foot 47 - Department of Radiology - University of ...

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