High-energy Midfoot Injury

Sharon · #1 ● 04-09-2014, 12:07 PM

An intertarsal injury affects the region between the Lisfranc area distally and the Chopart area proximally. This type of injury can involve the navicular-cuneiform or intercuneiform joints of the midfoot, or the cuneiform bones.

Such injuries can occur in sports and may either be subtle or the result of high-energy trauma, making them more apparent (as shown in the case here). The mechanism of injury is similar to a Lisfranc midfoot injury or a similar twisting motion and can sometimes be part of a Lisfranc fracture dislocation.

High-energy intertarsal injuries are often seen in polytrauma cases and are usually accompanied by other injuries to the foot or elsewhere in the body. In patients with multiple injuries, intertarsal injuries and fractures may be identified during the secondary survey. For unconscious patients, it is crucial to look for signs such as unusual swelling, crepitus, or deformity. If an intertarsal injury is suspected, foot x-rays are recommended.

The x-ray below illustrates a severe foot injury with complete anatomical disorganization.

In cases of severe soft-tissue injury, potential vascular compromise, or coexisting conditions like diabetes, external fixation might be the only immediate treatment option. Reconstruction could be considered at a much later stage.

The photograph below shows a severe high-energy open fracture.

Plain x-rays can often reveal the injury pattern, while CT scans with sagittal and coronal reconstruction are useful for obtaining a three-dimensional understanding of the injury.

No information was provided regarding the outcome of the foot.

Imagine someone grabbing your foot and twisting it with such force and speed that it results in this severe injury.