Left foot pain after MBA

18 year-old man presented after MBA. He ambulatory on scene or at ED. Left mild medial midfoot pain was complaint but without any abrasion or echymosis on dorsal or plantar foot.

Here are his left foot x-ray (AP and oblique view)

1. What clinical decision rule could guide the utility of x-ray ?
     Ottawa Foot Rule

2. What are the radiographic abnormalities ?
     Widening of space between the 1st and 2nd MT base.  Diastasis > 2mm is diagnostic of Lisfranc injury.

3. What is your diagnosis ?
     Lisfranc Injury.

4. What is Lisfranc Joint ?
     The Lisfranc joint, or tarsometatarsal articulation of the foot, is named for Jacques Lisfranc (1790–1847), a field surgeon in Napoleon's army.

5. What is the clinical significant of this injury ?
    Lisfranc joint fracture–dislocations and sprains carry a high risk of chronic secondary disability.

6. What is the different between Lisfranc joint and Lisfranc joint complex ?
   
7. What clinical sign could be found on this kind of injury ?
    Plantar ecchymosis sign
    Palpable tender on medial aspect of midfoot   
    Patient unable to bear weight while standing on tiptoe
    Check for dorsal pedis pulse and distal capillary refilling tie

8. What is the radiographic pitfall when interpretating the film ?
   Weight-bearing radigraphy is necessary to reveal minor injury.
   Compared with the normal side
   "Fleck sign"-small avulsed fragments within the joint space

    Here is the patient unaffected side x-ray: