Musculoskeletal case studies for medical students

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A 22 year old female was involved in a horse riding accident.

The left foot was grossly swollen.

Neurovascular intact, no other injuries.
Initial X ray
Description AP X ray
X ray
Description Lateral view
Problem The 22 year old horse rider with a swollen left foot after an accident. How this was treated, and why.
X ray after treatment
Description After initial reductio with K wires
Post management further view
Description Final fixation with screws
Classification This is a Lis Franc facture dislocation of the mid foot. Note the metatarsals of the lesser toes are displaced laterally at Liz Franc's joint. The second metatarsal head is displaced superiorly on the lateral view. The MP joint of the big toe is also dislocated
Discussion of management The dislocations need to be reduced as an emergency. The fixation is rarely stable enough and needs temporarily be fixed by percutaneous K wires (X ray on left). If you are at a small hospital, refer the patient at this stage for specialist internal fixation. 10 days after the definitive fixation was done using screws and K Wires ( Right x ray). Most Lis Franc injuries need accurate reduction by means of open operation. Reduce early but this definitive arthrodesis, or fixation without arthrodesis, only after the swelling has settled. Not all Liz Franc injuries are this gross. The subtle injuries must not be missed. Bruising on the sole under the 2nd MP joint may indicate this injury. If in doubt do a stress x ray. The Liz Franc joint will sublux, if there is a problem.


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