A 20-year-old woman presents to your facility as a trauma code. She was an unrestrained passenger in a high-speed motor vehicle collision and was ejected. She is awake and alert, complaining primarily of chest wall pain and bilateral lower leg pain. Her medical history is unremarkable, and currently all her vital signs are stable. Primary survey, including some preliminary radiographs, shows numerous rib fractures and bilateral tibia and fibula fractures.
On secondary survey, you notice that both of her feet are moderately bruised and swollen. The dorsum of the left foot is more tender than that of the right. Good pulses are present, and the patient is able to wiggle her toes. A radiograph of the left foot is shown.
Answer
The radiograph shows a moderate amount of soft-tissue swelling, as well as a separation injury of the midfoot. Specifically, the bases of the first and second metatarsals are fractured/dislocated from the first (medial) cuneiform and the second (intermediate) cuneiform. An injury of this sort is typically referred to as a Lisfranc injury. Treatment usually consists of open reduction and internal fixation, which this patient underwent.
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