Fractures of the Foot

FRACTURES OF THE MIDFOOT AND FOREFOOT
LISFRANC FRACTURE-DISLOCATION
Myerson Classification
Total incongruity : lateral (A1), dorsoplantar (A2)
Partial incongruity : medial dislocation (B1), lateral dislocation (B2)
Divergent : partial displacement (C1), total displacement (C2)

Mechanism of Injury
Motor vehicle accidents, Industrial accidents, sports injury
Examination
Tenderness and haematoma over the dorsum of midfoot
Feel for dorsalis pedis pulse and capillary refill
X-rays
AP, oblique and true lateral of foot (weight bearing)
Normal X-rays should have the following features:
AP view :medial border of 2nd MT should line up with medial border of middle
cuneiform
Oblique view :medial border of 4th MT should line up with medial border of cuboid
Lateral view :no dorsal displacement of any metatarsal bases (Fleck sign)

Management
Backslab. Elevate the affected foot.
Document any neurovascular injuries
Admit to Ortho Dept

FRACTURE OF THE 5TH METATARSAL BASE
Avulsion fracture : avulsion caused by peroneus brevis
Jones fracture : fracture at the metaphyseal-diaphyseal junction of shaft

AVULSION FRACTURE
Mechanism of Injury
Acute inversion with plantar flexion of the foot
Examination
Tenderness and swelling over the base of 5th metatarsal bone
X-rays
AP and oblique of the foot
AP and lateral of the ankle if indicated to exclude ankle fractures
Management
Undisplaced fracture : Crepe bandage. PWB crutches. Analgesics. TCU Ortho 1/52
Displaced fracture : Backslab. NWB crutches. Analgesics. TCU Ortho SOC 1/52

JONES FRACTURE
Mechanism of Injury
Inversion stress injury to the foot, often a stress fracture that becomes an acute displaced fracture
Examination
Tenderness and swelling over the base of 5th metatarsal bone
X-rays
AP and oblique of the foot
AP and lateral of the ankle if indicated to exclude ankle fractures
Management
Undisplaced fracture : Backslab. NWB crutches. Analgesics. TCU Ortho SOC 1/52
Displaced fracture : Backslab. Admit to Ortho Dept

FRACTURE OF THE METATARSAL SHAFTS
Mechanism of Injury
Direct trauma
Management
Undisplaced Fractures :
Backslab. NWB crutches. Analgesics. TCU Ortho SOC 1/52
Displaced Fractures :
2nd - 4th MT fracture : M&R under analgesia. Backslab. NWB crutches. Analgesics.
TCU Ortho SOC 1/52
Open Fractures :
Dressing with clean gauze.
IV cefazolin 1g stat.
Admit to Ortho Dept for surgery
FRACTURES OF PHALANGES AND INTERPHALANGEAL JOINTS
Big toe :
Undisplaced or minimally fractures can be treated with buddy splinting. Analgesics. TCU Ortho SOC 1/52
Grossly displaced fractures of the proximal phalanx: consider admit for ORIF.
Second to fifth toes:
Buddy splint and analgesics. TCU Ortho SOC 1/52

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FRACTURES OF THE HINDFOOT
CALCANEUM FRACTURES
Classification
Extraarticular fractures : Anterior process, tuberosity, extraarticular body fractures
Intraarticular fractures : Joint depression, tongue-type fractures
Mechanism of Injury
Fall from height
Motor vehicle accident
Examination
Tenderness and swelling over the heel
Exclude injury to the ankle, knee, hip, and spine
X-rays
Axial and lateral views of the calcaneum
Broden's view to look at subtalar joint congruity
Management
Extraarticular fractures:
Crepe bandage. NWB crutches. Analgesics. TCU Ortho SOC 1/52.
Admit patient for avulsion break fracture of tenoachilles.
Intraarticular fractures:
Undisplaced : Backslab. NWB crutches. Analgesics. TCU Ortho SOC 1/52
Displaced : Backslab. Admit to Ortho Dept

TALUS FRACTURES
Anatomical Classification
Lateral process fractures
Posterior process fractures
Talar head fractures
Talar body fractures
Talar neck fractures
Mechanism of Injury
Hyperextension of the ankle due to motor vehicle accident or fall from height (for neck fractures)
X-rays
AP and lateral views of ankle and foot
Management
Undisplaced fracture : Backslab. NWB crutches. Analgesics. TCU Ortho SOC 1/52
Displaced fracture : Backslab. Admit to Ortho Dept