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

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2280 VII Imaging of the Musculoskeletal System A B C E D Figure 47-87. Divergent Lisfranc dislocation in a 34-year-old who was the front passenger in a motor vehicle accident. Radiographs were obtained in the emergency department. Anteroposterior (A) and oblique (B) views of the foot reveal lateral dislocation of the second through fifth metatarsals. The white arrow points to a fragment fractured off the base of the second metatarsal. The black arrowhead points to the base of the fourth metatarsal, which is not articulating with anything. C, The Lisfranc dislocation is less obvious on the lateral view, although the base of the fourth metatarsal (black arrowhead) is not articulating with anything. A closed reduction was attempted at the bedside but was unsuccessful. D and E, CT scans were obtained to aid in surgical planning. Straight axial (long-axis) (D) and coronal oblique (long-axis) (E) images through the Lisfranc joint show that none of the metatarsals (II to V) is articulating properly with its respective tarsal bone. Cu, cuboid; N, navicular. Ch047-A05375.indd 2280 9/9/2008 5:35:29 PM
47 Ankle and Foot 2281 47 Figure 47-87, cont’d F and G, Three-dimensional reformatted views help in understanding the multiplanar nature of the Lisfranc dislocation. F, Viewed from above, the second through fifth metatarsals can be seen to be dislocated dorsally and laterally. G, The view from below the foot (“Star Wars” view) shows a large fragment off the base of the second metatarsal (white arrow) and a smaller fragment off the third metatarsal (black arrow). Postoperative anteroposterior (H), oblique (I), and lateral (J) radiographs show that seven screws were required to restore the anatomic alignment of the Lisfranc joint. F G H I J Ch047-A05375.indd 2281 9/9/2008 5:35:31 PM
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Ankle and Foot 47 - Department of Radiology - University of ...

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