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Further injury, consisting of rotation or displacement, occurs with the pull of the peroneus brevis.18,24,25 Tuberosity fractures, including the avulsion fracture, were classified in 1960 by Stewart26 and based on the anatomic location of the fracture (Table 16-2, Figure 16-12).

A clinician should have a high index of suspicion for a tarsometatarsal joint fracture–dislocation when metatarsal base and isolated cuneiform and cuboid fractures are observed.

Cuboid fracture is also a rare injury, accounting for 5% of tarsal fractures.69 Rarely an isolated fracture, this injury frequently occurs with another lateral column fracture or tarsometatarsal joint fracture–dislocation. In: Christman RA. However, isolated base fractures without Lisfranc fracture–dislocation are rare secondary to the strong tarsometatarsal joint complex (Figure 16-6B). Medial cuneiform avulsion fractures. Patients who suffer navicular fractures often have other associated foot fractures 47% to 50% of the time.90–92. A hypoechoic band, cortical step-off, and periosteal reaction can be indicative of a fracture.

Falls from a height, equestrian accidents, stepping off a curb, and sports-related injuries are other commonly reported low-energy activities associated with tarsometatarsal joint fracture–dislocation.

The dorsoplantar (anteroposterior) view is beneficial for determining transverse plane subluxation, metatarsal length, and the metatarsal parabola. The hallux appears shortened; the extensor tendons are relaxed, and the first metatarsal head is prominent plantarly. The most frequent direct trauma is a crush injury, caused by dropping a heavy object on the toe (Figure 16-2); this is the most common cause of middle and distal phalangeal fracture. Radiographically, in the lateral view, the anterior cortex appears thickened and contains a lucent line running through it.

Prime-Mitglieder genießen Zugang zu schnellem und kostenlosem Versand, tausenden Filmen und Serienepisoden mit Prime Video und vielen weiteren exklusiven Vorteilen. Schematic representation of Quenu–Kuss Lisfranc fracture–dislocation classification.62 (From Figure 19-9 in Spinosa FA.
Fractures of the metatarsal head may have an intra-articular component whereas the neck fracture is usually a transverse or short oblique pattern, thus without crossing the metaphysis and rarely intra-articular.

Stress fractures frequently lack an inciting event and there is an insidious onset of symptoms.

Navicular tuberosity fracture occurs 24% of the time (Figure 16-26).91 This injury results from MVA, fall, sprain, and twisting injury.92 The mechanism of injury involves forced eversion of the foot, resulting in avulsion of the tuberosity.89,91,93,94 However, there is some controversy as to which anatomic structure actually causes the avulsion fracture.

Despite the different anatomic locations, fifth metatarsal fractures, in general, are commonly associated with ankle, tarsal, and tarsometatarsal injuries.
Axial loading to the first metatarsophalangeal joint in a position of hyperextension results in dorsal dislocation. Spontaneous reduction and partial rupture of the Lisfranc ligament, commonly diagnosed as a midtarsal joint sprain, have been implicated as potential causes of the subtle nature of some presentations.44,50 Overlapping shadows, inappropriate positioning, and suboptimal exposure makes radiographic identification of anatomic landmarks and joint instability difficult.37,51 For example, one study noted that only 61% of Lisfranc injuries were detected radiographically. The appearance of a stress fracture is dependent on the time radiographs are obtained following the injury and the type of bone. This reference work presents a classification of fractures of all long bones. Elevation of the first metatarsal alters the weight-bearing surface and can lead to altered gait and additional weight-bearing stress applied to the second metatarsal long term. Diaphyseal fractures are usually a long oblique or spiral fracture (Figure 16-6A).

With this in mind, classifications continue to be used for all of the intended uses, including guiding treatment and predicting outcomes.

These injuries were treated with open reduction internal fixation (ORIF), should closed reduction under general anesthesia fail. 1976;120(1):79–83. Body fractures occur when the foot strikes the ground in a plantarflexed position with rotational motion applied to the forefoot. The secondary injuries are parenthesized. This original case series involved fractures at two anatomic locations, the metaphyseal–diaphyseal junction and the proximal diaphysis of the fifth metatarsal.28,29 More recently, the Jones fracture has been strictly defined as a transverse fracture 1.5 cm distal to the fifth metatarsal tuberosity without distal extension beyond the fourth–fifth metatarsal articulation (Figure 16-12A).30 However, just as in Jones’s original case series, the strict definition of the fracture is often confused with proximal diaphyseal fractures due to the close proximity of the fractures anatomically. In order to better describe the break, each bone in the body is considered to consists of three parts, each constituting of roughly one third of the bone. Fracture severity depends on the magnitude and direction of the traumatic force. FIGURE 16-25. An anatomic classification is most commonly used, describing fractures by the metatarsal involved and the location within the metatarsal.

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