Lower Limb: Midfoot, Metatarsal & Toe fractures

Question 1

describe what a midfoot(or Lisfranc) fracture involves

Answer 1

fracture of the base of the 2nd metatarsal

Question 2

what injury is midfoot fracture associated with

Answer 2

dislocation of the base of the 2nd metatarsal, with or without dislocation of the other metatarsals at the tarso-metatarsal joints

Question 3

describe the ligament involvement in a midfoot fracture/dislocation

Answer 3

ligament from the medial cuneiform to the base of the 2nd metatarsal no longer holds the metatarsal in joint

Question 4

describe how a midfoot fracture/dislocation may be easily missed on an x-ray

Answer 4

fracture may only be small flake fracture, also dislocation can be hard to see on x-ray too
(CT required if suspicion)

Question 5

how do midfoot fractures/dislocations usually present

Answer 5

grossly swollen and bruised foot, unable to weight bear

Question 6

what treatment is recommended for midfoot fracture/dislocation

Answer 6

closed or open reduction with fixation using screws

Question 7

which metatarsal fracture is most common

Answer 7

base of the 5th metatarsal

Question 8

describe the mechanism by which the 5th metatarsal bone is fractured

Answer 8

due to an inversion injury with an avulsion fracture at the insertion of the peroneus brevis tendon

Question 9

describe how fractures of the 5th metatarsal base are treated

Answer 9

walking cast, supportive bandage or wearing of a stout boot for 4-6weeks

Question 10

describe what a Jones fracture is

Answer 10

when the bone fracture in the region of the proximal diaphysis

Question 11

what problems can arise from a Jones fracture

Answer 11

area has relatively poor blood supply and risk of non-union is higher(around 25%), even in undisplaced fractures

Question 12

what Jones fractures may require fixation, usually with single screw

Answer 12

displaced or fractures on very active area

Question 13

what treatment is used for non-union Jones fractures

Answer 13

fixation and bone grafting

Question 14

what metatarsal is uncommonly fractured

Answer 14

first, due to its thickness and strength

Question 15

what metatarsals are commonly fractured, usually with multiple fractures

Answer 15

the lesser metatarsals

Question 16

which metatarsal is a common site of stress fractures

Answer 16

2nd metatarsal

Question 17

how are lesser metatarsal fractures treated

Answer 17

minimally displaced = cast

multiple/undisplaced = stabilised with K wires

Question 18

what treatment is needed for majority of toe fractures

Answer 18

stout boot

Question 19

how are toe dislocations treated

Answer 19

with closed reduction and either neighbour strapping or wiring