Ucsf: Video E 48 Part 9 Msk Skeletal Trauma (Learning Radiologly Foot)

Front 1

What are the small bones located at the head of the 1st metatarsal

Back 1

sesmoids

Front 2

What is the Chopart (showpart) joint

Back 2

the junction between the hindfoot and midfoot. (talus and navicular on lateral view)

Front 3

What is the hindfoot

Back 3

the talus and calcaneous

Front 4

What is the junction between the midfoot and metatarsals

Back 4

the lisfanc joints

Front 5

What is the midfoot

Back 5

Navicular (behind the cuneiforms), cuneiforms (big toe), and cuboid (little toe)

Front 6

What is the forefoot

Back 6

Metatarsals and phalanges

Front 7

What is the most common fx of the 5th metatarsal

Back 7

avulsion fx

Front 8

What is the cause and exact location of an avulsion fx of the 5th metatarsal

Back 8

inversion and avulstion of the 5th metatarsal tuberosity

Front 9

What is the cause of an avulsion fx of the 5th metatarsal tuberosity

What is considered adduction of the toes?

Back 9

pull of the peroneus brevis tendon

There is an imaginary line on the 2nd toe and if a toe is moving towards that line it is considered adduction. Note for the fingers it is the middle finger.

Front 10

Where does the peroneus brevis insert

Back 10

Front 11

Where is an avulstion fx of the 5th metatarsal (i think tuberosity and styloid are used interchangeable)

Back 11

Front 12

What is a pitfall of diagnosing a 5th metatarsal avulsion fx

Back 12

normal apophysis of child (it is oriented longitudinaly)

Front 13

Where is the location of a true jones fx

Back 13

transverse fx of the base that occurs3/4 to 1' from the base of the 5th metatarsal

Front 14

What heals more slowly jones fx or avulsion fx

Back 14

jones fx (has increased risk of delayed or fibrous union)

Front 15

What is the cause of stress fx of the metatarsal

Back 15

repetitive microfx

Front 16

What demographic do stress fx of the metatarsals occur in

Back 16

dancers or soldiers

Front 17

What happens when the stress fx occur to the metatarsals

Back 17

microcallus formation which leads to reinforcement (endosteal thickening)

Front 18

In the metatarsal stress fx where does this mc occur

Back 18

2nd and 3rd MT

Front 19

What is the gold standard for detecting stress fx

Back 19

bone scan (100% sensitive after 72h)

Front 20

What is visible on a plain film in a stress fx

Back 20

the periosteal thickening

Front 21

What is the MC fx of the navicular

Back 21

avulsion fx of the dorsal aspect

Front 22

What is associated with a doral avulsion fx of the navicular

Back 22

avulsion of the dorsum of the calcaneous

Front 23

What is the cause of avulsion fx of the navicular

Back 23

twisting of the midfoot

Front 24

What is the best projection and tx for a navicular avulsion

Back 24

requires lateral projection and is treated conservatively

Front 25

Where is the dorsum of the navicular

Back 25

the top

Front 26

What is the MC fx tarsal bone

Back 26

calcaneous

Front 27

What is the MC mechanism for calcaneal injury

Back 27

falls or jumps from heigh

Front 28

What is more common intra-articular or extra-articular

Back 28

intra-articular (75%)

Front 29

What is important to evaluate in a calcaneal fx

Back 29

the subtalar joint

amount of depression of the posterior facet

Front 30

What is the subtalar joint

Back 30

the articulation of the calcaneous with the talus

Front 31

What are the superior articular surface facets

Back 31

posterior
middle and anterior facets

Front 32

What are the location of the articular facets of the talus and calcaneous

Back 32

posterior facet is the largest and is the major weight bearing surface
middle facet is anteromedial on sustentaculum tali
anterior facet is often confluent with middle facet

Front 33

The facets of the ankle, subtalar, and talocalcaneonavicular joints. A, Diagram of the talus from above to show the three-surfaced trochlea that fits into the mortise formed by the lower ends of the tibia and fibula. B, Diagram of the calcaneus from above to show the posterior facet (P) for the subtalar joint, separated by the canalis and sinus tarsi from the middle (M) and anterior (A) facets of the talocalcaneonavicular joint. The socket of this latter joint is completed by the spring ligament and the concavity of the navicular. C, Diagram of the talus from below to show its corresponding facets for the subtalar and calcaneonavicular joints. Cf. fig. 12-36. A broad arrow in A emphasizes that the head of the talus is directed anteromedially

Back 33

The facets of the ankle, subtalar, and talocalcaneonavicular joints. A, Diagram of the talus from above to show the three-surfaced trochlea that fits into the mortise formed by the lower ends of the tibia and fibula. B, Diagram of the calcaneus from above to show the posterior facet (P) for the subtalar joint, separated by the canalis and sinus tarsi from the middle (M) and anterior (A) facets of the talocalcaneonavicular joint. The socket of this latter joint is completed by the spring ligament and the concavity of the navicular. C, Diagram of the talus from below to show its corresponding facets for the subtalar and calcaneonavicular joints. Cf. fig. 12-36. A broad arrow in A emphasizes that the head of the talus is directed anteromedially

Front 34

What are the 3 landmarks that are used in boehlers angle

Back 34

anterior superior spine (calcaneus)
Posterior facet of the subtalar joint
posterior tuberosity

Front 35

boehlers angle

Back 35

Front 36

What is a normal boehlers angle

Back 36

20-40%

Front 37

Are stress fx of the calcaneous common

Back 37

no

Front 38

What demographic gets calcaneal fxs

Back 38

runners

Front 39

What portion of the calcaneous typicaly gets stress fx

Back 39

posterior/dorsal aspect

Front 40

What are the plain film findings

Back 40

2-4 wks normal
then sclerotic band will form

Front 41

What 2 studies will be more sensitive for detecting stress fx in general

Back 41

bone scan and MRI

Front 42

What should the lateral border of the first metatarsal line up with

Back 42

the lateral boder of the first (medial) cuneiform

Front 43

anatomy of foot

Back 43

Front 44

What is the normal anatomic relation of the 2nd metatarsal

Back 44

the medial border of the 2nd metatarsal should align with the medial border of the 2nd cuneifom

Front 45

What is the normal anatomic relation of the 3rd metatarsal and cuneiform

Back 45

the medial and lateral border of the 3rd metatarsal should align with the medial and lateral borders of the 3rd (lateral) cuneiform.

Front 46

What is the normal anatomic relationship of the 4th toe

Back 46

the medial border of the 4th metarsal should align with the medial border of the cuboid

Front 47

What is the normal anatomic alignment of the lateral margin of the 5th metatarsal

Back 47

the 5th metatarsal styloid should project lateral to the cuboid by less than 3mm (OBLIQUE VIEW)

Front 48

What is the most common dislocation of the foot

Back 48

lisfranc

Front 49

how often are lisfranc fx missed

Back 49

20%

Front 50

What are the bones in which a lisfanc dislocation occurs

Back 50

the tarsal and metatarsal bones

Front 51

What is the MOI

Back 51

severe plantar flexion of the foot

Front 52

What activities commonly result in lisfranc fx/dislocaiton

Back 52

sports, MVC, falls

Front 53

What disease will predispose a pt to a lisfranc fx/dislocation

Back 53

diabetes

Front 54

What does the lisfranc ligament connect

Back 54

the base of the 2nd metatarsal diagnol with the the medial aspect of the first cuneiform

Front 55

What happens if there is a lisfranc dislocation and the lisfranc ligament stays intact

Back 55

there will be a fx of the lateral aspect of the 1st cuneiform or the base of the 2nd metatarsal.

Front 56

What are the 2 types of lisfranc fx/dislocations

Back 56

homolateral and divergent

Front 57

Where is the lisfranc ligament

Back 57

Front 58

What is a homolateral lisfranc fx/dislocation

Back 58

all MT are dislocated to the same side (usually 2-5th MT dislocated laterally)

Front 59

What is more common the homolateral or divergent

Back 59

homolateral

Front 60

What is a divergent type lisfranc dislocation

Back 60

medial displacement of the 1st metatarsal and lateral displacement of 2nd through 5th MT

Front 61

What is the divergent type of lisfranc associated with

Back 61

frx of the 1st cuneiform

Front 62

Is it possible for the divergent type to only involve medial displacement of the 1st metatarsal

Back 62

yes

Front 63

What is a more sever fx a divergent or homolateral lisfranc

Back 63

divergent

Front 64

What fxs and other dislocations are associated with a lisfranc dislocation

Back 64

base of the 2nd metatarsal
cuboid
fracture of shaft of metatarsal
dislocation of 1st adn 2nd cuneiforms and cuneonavicular joints
fx of the navicular

Front 65

Is there a relationship between lisfranc and charcot arthropathy

Back 65

yes, lisfranc are uncommon in the general population but among diabetics it is more common.

Front 66

What is a more sever fx a divergent or homolateral lisfranc

Back 66

divergent

Front 67

What % of pt with charcot arthropathy may have a lisfranc dislocation

Back 67

45%

Front 68

What fxs and other dislocations are associated with a lisfranc dislocation

Back 68

base of the 2nd metatarsal
cuboid
fracture of shaft of metatarsal
dislocation of 1st adn 2nd cuneiforms and cuneonavicular joints
fx of the navicular

Front 69

What is another clue that a lisfranc dislocation may be present besides the metatarsals lining up with there respective tarsal bones

Back 69

if there is a gap of greater than 5 mm between the bases of the 1st and 2nd metatarsal or 1st and 2nd cuneiform

Front 70

Is there a relationship between lisfranc and charcot arthropathy

Back 70

yes, lisfranc are uncommon in the general population but among diabetics it is more common.

Front 71

What % of pt with charcot arthropathy may have a lisfranc dislocation

Back 71

45%

Front 72

What is another clue that a lisfranc dislocation may be present besides the metatarsals lining up with there respective tarsal bones

Back 72

if there is a gap of greater than 5 mm between the bases of the 1st and 2nd metatarsal or 1st and 2nd cuneiform

Front 73

What is the MOI for a chopart fx/dislocation

Back 73

falls from heights, MVC, sports related (basketbal)

Front 74

Where do chopart fx occur

Back 74

the junction of the hind foot and midfoot

Front 75

What is the joint of the hindfoot and midfoot

Back 75

tarsal --- navicular
calcan---cuboid

hindfoot is talus and calcaneous
midfoot is navicular and cunieform and other tarsal bones

Front 76

What are the imaging finds of a chopart fx

Back 76

medial and dorsal displacement of distal fragments although lateral displacement can occur

Front 77

Does the talus continue to articulate with the tibia

Back 77

yes

Front 78

What are associated fx of the a chopart fx

Back 78

calcaneous
cuboid
navicular

Front 79

What does a chopart dislocation look like

Back 79

Front 80

What happens to the navicular compared to the talus in a chopart dislocation

Back 80

it dislocates superiorly (dorsal) compared to the talus (on lat view)

Front 81

On the frontal view (superior view) what how is the navicular and talus dislocated

Back 81

there is lateral displacement of the entire foot compared to the talus.