Lisfranc Fractures: are the most common type of foot and ankle injuries,
and among the easiest missed given its presentation.
This injury invovles the first three tarso-metatarsal joints (where the first three metatarsals articulate with the three cunieforms).
This injury pattern is well-demonstrated on a plain film of the foot,
which shows subtle widening of this joint.
In a foot with multiple different injury patterns,
it is essential to look carefully at the lisfranc joint to determine its involvement.
The Fifth Metatarsal: is a site that is notorious for numerous different types of fractures.
The commonest of these is an avulsion fracture of the 5th metatarsal styloid/pseudo-Jones fracture/Dancer's fracture, thought to be secondary to forcible inversion of the foot in plantar flexion,
such as in climbing up steps or in stepping on a curb.
A Jones fracture is an extra-articular fracture at the base of the fifth metatarsal.
This fracture is ascribed to significant adduction forces to the forefoot while in plantar flexion.
Ankle Fractures: can be divided up as follows-->
A.
Three-Part fracture of the ankle: involving the medial malleolus,
the posterior malleolus,
and the lateral malleolus.
This fracture is unstable and is highly associated with ligamentous injury.
The Weber classification is commonly employed in describing these fractures.
B.
Pilon fracture: involves the distal tibia and results from an axial loading type of injury which drives the talus into the tibial plafond,
such as landing from a fall.
C.
Triplane fractures: is regarded typically as a Type IV Salter-Harris fracture,
comprising of a vertical fracture through the epiphysis,
a horizontal fracture through the physis,
and an oblique fracture through the metaphysis.
This will only occur in adolescents,
and is a function of the medial aspect of the physeal plate closing,
leaving the lateral aspect of the plate more vulunerable to fracturing.
D.
Tillaux fractures: Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis,
commonly seen in children and adolescents.
E.
Wagstaffe-LeForte fractures: avulsion fracture of the medial aspect of the distal fibula secondary to avulsion of the anterior tibiofibular ligament attachment.
Calcaneal Fractures: are fractures that involve the calcaneus.
These fractures are usually secondary to a fall from a certain height,
and will always necessitate further imaging of the spine to rule out vertebral column fractures that are highly associated with this pattern of injury secondary to axial loading.
As a general rule,
they can be divided up into extra-articular fractures (25-30%) and intra-articular fractures (70-75%).
A plain film radiograph will usually be enough to determine if the calcaneus is involved in a fractured deformity,
with a CT being useful to determine the precise pattern of injury.