0071643192.pdf

ORTHOPEDICS

MECHANISM

Can be quite varied (axial load, crush injury, or rotational stress); may occur

with relatively minor trauma

DIAGNOSIS

■ Plantar ecchymosis signis a bruise over the plantar aspect of the midfoot.

■ Gap>1 mm between the bases of the first and second metatarsal (see

Figure 4.14).

■ Fleck sign is an avulsion fracture of the base of the second metatarsal on

the medial side. It is pathognomonic of a Lisfranc fracture.

TREATMENT

Emergent orthopedic referral

COMPLICATIONS

Frequently associated with dorsal pedis artery injury, early arthritis, and chronic

pain

JONESFRACTURE

DIAGNOSIS

Jones fracture is a transverse fracture through the metaphyseal-diaphyseal

junctionof the fifth metatarsal. The fracture line will be at least 1.5 cm distal

to the base of the fifth metatarsal (see Figure 4.15).

TREATMENT

Cast/splint, non-weight-bearing, and orthopedic referral for ORIF evaluation

FIGURE 4.14. Lisfranc fracture. The space between the base of the first and second

metatarsal is widened, which indicates disruption of the tarsometatarsal joint.

A fracture of the base of the

second metatarsal on the

medial side is pathognomonic

of a Lisfranc fracture.

Midpart (navicular, cuboid,

cuneiforms).

Separated from hindpart by

Chopart’sjoint.

Separated from forepart by

Lisfranc’sjoint.