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This case shows laterally dislocated 2nd through 5th metatarsal bones relative to the tarsals and suggests a Lisfranc dislocation, named after Jacques Lisfranc, who, as a field surgeon in Napoleon’s army, described an innovative technique to amputate the forefoot of soldiers as a means to treat frostbite. Of the two basic types, our patient appears to have the Homolateral type, wherein all the metatarsals are dislocated to one side.
Further reading:
http://emedicine.medscape.com/article/1236228-overview
Observation
Clinical History: Pain, swelling, ankle and foot fractures
Technique: DX left foot (3 views)
Compared with prior study dated February 2, 2010 (21:03)
The presence of cast material obscures subtle bony detail, limiting the study. At least three well corticated osseous structures posterior to the talus are again seen, unchanged. Partly imaged fractures of the medial and lateral malleolus show no significant interval change and are described in detail in the accompanying ankle films. The mineralization of the visualized bony structures is well maintained. Soft tissue swelling around the ankle joint is again seen and appears unchanged. Compared to the pre-reduction film, a lateral displacement of the second through fifth metatarsals and possibly also of the first metatarsal in relation to the tarsal bones, is now more apparent.
Impression
INTERVAL PLACEMENT OF CAST. LATERAL DISPLACEMENT OF THE SECOND THROUGH FIFTH METATARSALS IN RELATION TO THE TARSAL BONES, AND PROBABLY OF THE FIRST METATARSAL IS NOW MORE APPARENT, SUGGESTIVE OF A LISFRANC DISLOCATION. FURTHER EVALUATION WITH MRI MAY BE OF BENEFIT. OTHERWISE STABLE STUDY OF THE LEFT FOOT.
Some Italians have rigged up a Nintendo Wii controller to control their PACS Viewer. One step closer to the ultimate radiology user interface!
59 year old male trauma patient has a right shoulder xray taken to rule out fracture. The images show the head of the humerus (upper arm bone) to be in front of and below its expected location. The shoulder joint has been dislocated. No fracture is seen. There may be related injuries to the muscles and ligaments of the shoulder, however these cannot be seen on xrays, a followup MRI would be the examination of choice for such an evaluation.
Observation
Clinical History: R/o fracture
Technique: DX right shoulder
No prior study is available for comparison
The mineralization of the visualized bony structures is well maintained. There is anterior and inferior dislocation of the humerus in relation to the glenoid fossa, with the humeral head in subcoracoid location. No acute displaced fracture is identified. Degenerative changes are seen in the acromioclavicular joint.
Impression
Anterior and inferior dislocation of the humerus. No acute displaced fracture is identified.
Let’s face it: mixing chemicals is dangerous. Even if you know what you’re doing, there’s always the risk of something going wrong. So was the case of today’s John Doe:
Clinical History: Chemical explosion (patient mixing chemicals when it exploded)
Technique: DX right hand, 3 views
There is complete comminuted fracture of the base of the first metacarpal with angulated dorsal displacement and intraarticular extension. There is also minimally displaced corner fracture at the ulnar side of the base of the first proximal phalanx also with intraarticular extension. Possible tuft fracture. There are multiple comminuted/shattered phalangeal fractures from the third to the fifth digit with adjacent skin and soft tissue avulsion with some areas of traumatic amputation. Also seen is undisplaced to a slightly displaced fracture of the base of the fourth and fifth proximal phalanx.