1. Ankle and foot fractures

2. Measured angle is from 20-40 degrees
Bohler’s Angle
Measured angle is from degrees
Calcaneal fracture from
Angle is measured by posterior to middle part of calcanues. Cross with anterior line to midpoint of calcaneus

3. Calcaneal fractures
Best diagnostic clue: Fracture line & Flat Bohler’s Angle
Land from 75% height/ high-impact
Don Juan fracture
lover's fracture
Low Bohler angle, suspect a lumbar fracture as well

4. Complications
Possible AVN due to high amount of blood supply running through the area

5. First & second metatarsals Medial & middle cuneiforms
Lisfranc Joint
First & second metatarsals
Medial & middle cuneiforms
Pain in midfoot
Inability to weight bear, especially on toes
Lisfranc injury
20% Missed
high risk of chronic pain and functional disability if goes unrecognized
Always a Lisfranc injury of the joint
Plantarflexed foot w/ axial loading will have midfoot compression

6. transverse ligaments connect lateral four metatarsal bases
no ligament between 1st & 2nd metatarsal bases
joint capsule & dorsal ligament… minimal support ……..prone to injury
Almost invariably involve metatarsal fractures……………
39%2nd metatarsal, cuboid, cuneiform, navicular

7. Signs of a Lisfranc injury
1st MT …no incongruency
2nd MTAP view
3rd MToblique view
"fleck sign” medial cuneiform-2nd MT space
No Subluxation at naviculocuneiform
No "step-off”…..MT shaft never more dorsal than its tarsal bone
When you fx lisfranc ligament, all the other metatarsals will go lateral

8. Jones fracture base of 5th metatarsal
….metaphyseal-diaphyseal junction
Not IntraArticular
Roy Jones – boxer 5th metacarpal is a boxer’s fx so jones is a 5th metatarsal fx
At tubercle, you have ligament attaching, would be called avulsion fx if it happened there
Within 1.5 cm distal to tuberosity of 5th metatarsal
Don’t confuse with avulsion fracture of 5th metatarsal tuberosity (lateral band plantar aponeurosis)
An oblique radiograph is essential to accurately assess this fracture

9. Jones Fracture proximal diaphysis 5th MT …risk for nonunion
Trauma between insertion of fibularis(peroneus) brevis and fibularis(peroneus)tertius tendons
plantar flex and strong adduction force at forefoot
proximal diaphysis 5th MT …risk for nonunion
Left – avulsion fx caused by plantar aponeurosis
Right – Jones fx

10. Talar Fractures Neck & Body
Retrograde blood supply from sinus tarsi arteries entering at the neck (most common) risk of AVN of body
Hawkins' sign: Thin zone of subcortical lucency of the talar dome
Hawkins' sign indicates an intact talar body blood supply
AVN of body is of concern, look for Hawkin’s sign (Stephen Hawkin’s can’t use his body)

11. Maisonneuve fracture
Ankle Mortise injuries …Medial Malleolar or Mortise…. ……..Entire Fibula needs X-Ray views
Fibular fracture not seen in ankle X-Ray film (it’s too proximal)
UNSTABLE FRACTURE

12. Tillaux fracture Salter-Harris III lateral distal tibia.
Unique to early adolescents… yrs old
Distal tibial physis fuses medial to lateral…. lateral physis relatively weak/prone to fracture

13. Pilon Fracture
Comminuted fracture of the distal tibia with intraarticular extension into the plafond
Type I: Nondisplaced
Type II: Same as type I, but with displacement
Type III: Multifragmented
Plafond – ankle roof – pilon
Pilon = big pile of mess

14. Weber C
Weber B
Weber A
Widening at Weber C – need a full fibular view to get a better idea if there is a fracture
C – above sea level
B – baseline
A - below

15. Cuboid Fracture
Entrapment between the calcaneus and 4th and 5th metatarsals
AKA nutcracker’s fracture.

16. Navicular Fracture
Navicular tuberosity avulsion Posterior tibial tendon avulsion
StressPartial or complete fracture in sagittal plane

17. Navicular Fractures Avulsion fractures most common…47-67%
Body fractures commonly associated with other midfoot injuries
Navicular stress fractures….59% are track and field athletes
Uncommon in general population
BodyType III has worst prognosis
86% of non-displaced stress fractures heal
Up to 14% treated correctly do not return to previous activities

18. Köhler Disease
Self limiting avascular necrosis of navicular in child < 6 years
Collapsed navicular or normal navicular with increased density + fragmentation
K – kohler – kid - kollapse

19. Freiberg Infraction
Best diagnostic clueSclerosis and flattening of “2nd metatarsal head”…Long 2nd metatarsal susceptible to increased stresses…Involved 85%
Trauma is primary event
Vascular damage/compression
subchondral marrow change with hyperintense edema

20. Metatarsal Stress Fractures
March fracture/fatigue fractureDistal 3rd of metatarsal
Due to recurrent stress….On feet prolonged periods…..soldiers/hikers/organists/doctors
most commonly occur in the 2nd & 3rd metatarsals