Midfoot sprain vs fracture = Lisfranc injury?

[chakdaddy]

The whole idea of suspicious x-rays, suggesting a fracture but requiring an MRI to confirm, and the ultimate diagnosis of a midfoot sprain makes me think that the initial x rays showed joint widening and a mild lisfranc dislocation, but that the MRI didn't show a fracture, just some ligamentous injury. I can't offhand think of another situation that would cause them to waffle about a fracture based on the x-ray (they might be thinking stress fracture clinically and not see it on the x ray, but the fracture suspicion seemed to come after the x ray.)

The only thing that doesn't add up, I wouldn't think a mild lisfranc injury would just be 'day to day' like the press release is saying.

[exculpatory]

chak

You obviously know 100000x more ortho than I do. Please expand. I have never heard of lisfranc. But I never deal in orthopedic issues either. Just good old hormones and electrolytes.

Tx

EX

[BRUNiNHO91]

Hurt my head just reading that...is everything you said, a good thing, or a bad thing? Can we get an simple explanation for the less intelligent people here, such as myself? Kay thanks. lol

[Collinto]

Causes
This type of injury classically occurred when a horseman fell while riding, having trapped his foot in the stirrup or fell into a drain. At present, such an injury happens typically when one steps into a hole and the foot twists heavily. Falling from a height of two or three stories can also cause this fracture. American football players occasionally get this injury, often when they have their foot pointing down and someone lands on their heel.

Treatment
Treatment options include operative or non-operative treatment. If the dislocation is less than 2 mm, the fracture can be managed with casting for 6 weeks. The patient's injured limb cannot bear weight during this period. For operative treatment, percutaneous screws +/- k-wire will be used for internal fixation of the fracture. Again, the patient's injured limb cannot bear weight. The screws/k-wires must be removed before weight bearing.

[Ed Pinkney]

Slow down there egghead.

[chakdaddy]

In that picture, the circle shows a lisfranc dislocation, which basically involves damage to the ligament connecting the 2nd metatarsal to the 1st cuneiform, and leads to the widening between the first two metatarsals you see in the picture. The 2nd metatarsal should basically be flush with the 1st cuneiform (where you can see the fragment in the circle.) But there isn't necessarily going to be a fracture, it might just be a dislocation; but I think that would be plenty bad anyway; and that is where my theory falls apart since it sounds like it turned out to be pretty mild.

But it makes sense since a lisfranc dislocation is the midfoot, and they are calling this a midfoot sprain; maybe they just thought they saw some very subtle widening of the space, and got worried that it might be a full on dislocation or fracture; but the MRI turned out not to be so bad.

Frankly I don't know much about the treatment or prognosis really, just what the x rays and MRIs look like. (and that didn't stop me from getting mixed up about which way the ligament goes before I corrected myself and fixed this post)

[nasbahceltic]

Always interesting to have someone with some expertise lend their insight. Thanks chakdaddy

[akola]

Great another guy playing Doctor Doctor. As if Doctor Rivers was stupid enough to let Paul return to the game and play thru the injury which probably agravated Pierce's injury.

[IEcelticfan]

meta wha ..... cunei who ....

j/k..thanks for the explain !!

[perfectblack999]

Great another guy playing Doctor Doctor. As if Doctor Rivers was stupid enough to let Paul return to the game and play thru the injury which probably agravated Pierce's injury.

lol if i'm not mistaken chakdaddy is a doctor or works in the medical field, no?

[BadWolf]

An x.ray of the foot is hard to interpret in many instances, so an MRI or CT is often required for detailed view.
I'm a bit surprised it turned out into such a story, it will just reflect bad on P2 (who's completelly innocent here). I doubt they'd do a scan for ordinary people, but P2 is a multimillion dollar investment.

[chakdaddy]

Great another guy playing Doctor Doctor. As if Doctor Rivers was stupid enough to let Paul return to the game and play thru the injury which probably agravated Pierce's injury.

lol if i'm not mistaken chakdaddy is a doctor or works in the medical field, no?

Yeah I'm a radiologist, so speculating about the xrays is right up my alley. Although musculoskeletal isn't my subspecialty. Someday when we're all speculating about what's wrong on Tony Allen's brain MRI, then I can really help.

[MyInsatiableOne]

Great another guy playing Doctor Doctor. As if Doctor Rivers was stupid enough to let Paul return to the game and play thru the injury which probably agravated Pierce's injury.

lol if i'm not mistaken chakdaddy is a doctor or works in the medical field, no?

Yeah I'm a radiologist, so speculating about the xrays is right up my alley. Although musculoskeletal isn't my subspecialty. Someday when we're all speculating about what's wrong on Tony Allen's brain MRI, then I can really help.

The problem with his brain is that it's missing