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 ...
2282 VII Imaging of the Musculoskeletal System A B D C Figure 47-88. Divergent Lisfranc dislocation in a 22-year-old who was driving on the highway when struck by another car going the wrong way. The patient also sustained a fracture of the contralateral femoral shaft. Anteroposterior (A) and oblique (B) radiographs demonstrate medial dislocation of the first metatarsal and lateral dislocation of the second through fourth metatarsals. The patient was taken to the operating room for open reduction and internal fixation of the femoral fracture with an intramedullary nail. Once the patient was fully anesthetized, the surgeon was able to apply longitudinal traction on the first ray and achieve closed anatomic reduction of the Lisfranc joint. C, Oblique port intra-operative radiograph. D, The patient returned to the operating room 1 week later, after the swelling had diminished, for elective fixation of the Lisfranc joint. is common for a base of the second metatarsal to be sheared off or avulsed. In some cases, axial oblique CT images can help to demonstrate subtle offsets at the tarsometatarsal joints, particularly when compared with the normal contralateral side (Fig. 47-89). In other cases, the dislocations along the Lisfranc joint may be manifest only when a lateral stress is applied to the forefoot. In these patients, the nonstressed CT scan may fail to demonstrate the degree of potential displacement (Fig. 47-90). • Arthritis 45 The hallmarks of osteoarthritis—nonuniform joint space narrowing accompanied by the formation of osteophytes, Ch047-A05375.indd 2282 9/9/2008 5:35:32 PM
47 Ankle and Foot 2283 47 LEFT LEFT A B C Figure 47-89. Subtle Lisfranc dislocation in a 39-year-old who fell backward down a 3-foot wall and injured the left foot. The patient bicycled home and continued to walk on this foot for 3 days before coming to the emergency department, concerned because the pain was not diminishing. Anteroposterior (A) and oblique (B) non–weight-bearing radiographs were obtained. Close scrutiny of the Lisfranc joint on the oblique view (dashed box) reveals small fractures off the bases of the second and first metatarsals (arrowheads). The Lisfranc joint appears anatomically aligned. The presence of the fragments along the Lisfranc joint raised the concern that this may represent a Lisfranc dislocation. C and D, CT scans were performed to assess the integrity of the tarsometatarsal joint. C, Axial oblique scan through both medial Lisfranc joints. In the normal right foot there is anatomic alignment across the first, second, and third cuneiform-metatarsal joints. In the injured left foot there is lateral subluxation of the first (white arrow) and third (black arrow) metatarsals as well as small fragments off the second metatarsal (white arrowhead) and second cuneiform (black arrowhead). D, Axial oblique scan, slightly more plantar and more angled than C, through the lateral tarsometatarsal joint. On the normal right side the articular surfaces of the fifth metatarsal (V) and the cuboid (Cu) are aligned (white arrows). On the left, the lateral corner of the fifth metatarsal (black arrow) is laterally displaced relative to the cuboid’s impacted lateral corner (open arrowhead). These findings confirmed that the patient had sustained a disruption of the Lisfranc joint, which was treated with a boot and non– weight bearing. D Ch047-A05375.indd 2283 9/9/2008 5:35:34 PM
- Page 25 and 26: 47 Ankle and Foot 2231 47 A B Figur
- Page 27 and 28: A C E B D F Figure 47-36. Accessory
- Page 29 and 30: 47 Ankle and Foot 2235 47 A B Figur
- Page 31 and 32: 47 Ankle and Foot 2237 47 Figure 47
- Page 33 and 34: 47 Ankle and Foot 2239 47 Figure 47
- Page 35 and 36: 47 Ankle and Foot 2241 47 Figure 47
- Page 37 and 38: 47 Ankle and Foot 2243 47 A Ankle/d
- Page 39 and 40: 47 Ankle and Foot 2245 47 A Figure
- Page 41 and 42: 47 Ankle and Foot 2247 47 ankle ten
- Page 43 and 44: 47 Ankle and Foot 2249 47 Figure 47
- Page 45 and 46: 47 Ankle and Foot 2251 47 A B C Fig
- Page 47 and 48: 47 Ankle and Foot 2253 47 Figure 47
- Page 49 and 50: 47 Ankle and Foot 2255 47 A B C D F
- Page 51 and 52: 47 Ankle and Foot 2257 47 A B C Fig
- Page 53 and 54: A B 47 Ankle and Foot 2259 47 Figur
- Page 55 and 56: 47 Ankle and Foot 2261 47 A C B D F
- Page 57 and 58: A B 47 Ankle and Foot 2263 47 Figur
- Page 59 and 60: 47 Ankle and Foot 2265 47 Figure 47
- Page 61 and 62: 47 Ankle and Foot 2267 47 Figure 47
- Page 63 and 64: • Calcaneal Fractures 6,18,33 47
- Page 65 and 66: 47 Ankle and Foot 2271 47 H J I LPT
- Page 67 and 68: 47 Ankle and Foot 2273 47 LPT N APC
- Page 69 and 70: 47 Ankle and Foot 2275 47 E F G H F
- Page 71 and 72: 47 Ankle and Foot 2277 47 Figure 47
- Page 73 and 74: 47 Ankle and Foot 2279 47 F G H Fig
- Page 75: 47 Ankle and Foot 2281 47 Figure 47
- Page 79 and 80: 47 Ankle and Foot 2285 47 A Figure
- Page 81 and 82: C D 47 Ankle and Foot 2287 47 Figur
- Page 83 and 84: 47 Ankle and Foot 2289 47 Figure 47
- Page 85 and 86: 47 Ankle and Foot 2291 47 D E F G F
- Page 87 and 88: A C B D 47 Ankle and Foot 2293 47 F
- Page 89 and 90: 47 Ankle and Foot 2295 47 Tarsal tu
- Page 91 and 92: 47 Ankle and Foot 2297 47 Figure 47
- Page 93 and 94: 47 Ankle and Foot 2299 47 A B C D E
- Page 95 and 96: 47 Ankle and Foot 2301 47 A B C Fig
- Page 97 and 98: 47 Ankle and Foot 2303 47 A B C D E
- Page 99 and 100: 47 Ankle and Foot 2305 47 A Figure
- Page 101 and 102: A B C 47 Ankle and Foot 2307 47 Fig
- Page 103 and 104: 47 Ankle and Foot 2309 47 Figure 47
- Page 105 and 106: A B C D E T1 T2fs T1fs IVGd F G H F
- Page 107 and 108: 47 Ankle and Foot 2313 47 A B C D E
- Page 109 and 110: A B 47 Ankle and Foot 2315 47 Figur
2282 VII Imaging <strong>of</strong> the Musculoskeletal System<br />
A<br />
B<br />
D<br />
C<br />
Figure <strong>47</strong>-88. Divergent Lisfranc dislocation in a 22-year-old who was driving on the highway when struck by another car going the wrong way.<br />
The patient also sustained a fracture <strong>of</strong> the contralateral femoral shaft. Anteroposterior (A) <strong>and</strong> oblique (B) radiographs demonstrate medial<br />
dislocation <strong>of</strong> the first metatarsal <strong>and</strong> lateral dislocation <strong>of</strong> the second through fourth metatarsals. The patient was taken to the operating room for<br />
open reduction <strong>and</strong> internal fixation <strong>of</strong> the femoral fracture with an intramedullary nail. Once the patient was fully anesthetized, the surgeon was<br />
able to apply longitudinal traction on the first ray <strong>and</strong> achieve closed anatomic reduction <strong>of</strong> the Lisfranc joint. C, Oblique port intra-operative<br />
radiograph. D, The patient returned to the operating room 1 week later, after the swelling had diminished, for elective fixation <strong>of</strong> the Lisfranc joint.<br />
is common for a base <strong>of</strong> the second metatarsal to be<br />
sheared <strong>of</strong>f or avulsed. In some cases, axial oblique CT<br />
images can help to demonstrate subtle <strong>of</strong>fsets at the<br />
tarsometatarsal joints, particularly when compared with<br />
the normal contralateral side (Fig. <strong>47</strong>-89). In other cases,<br />
the dislocations along the Lisfranc joint may be manifest<br />
only when a lateral stress is applied to the forefoot. In these<br />
patients, the nonstressed CT scan may fail to demonstrate<br />
the degree <strong>of</strong> potential displacement (Fig. <strong>47</strong>-90).<br />
• Arthritis 45<br />
The hallmarks <strong>of</strong> osteoarthritis—nonuniform joint space<br />
narrowing accompanied by the formation <strong>of</strong> osteophytes,<br />
Ch0<strong>47</strong>-A05375.indd 2282<br />
9/9/2008 5:35:32 PM