Fractures of the Midfoot and Forefoot SAQ

A 28-year-old man with a crush injury to his right foot from heavy farm machinery. Very swollen and generally tender. No wounds to foot. Not weight-bearing.

1. a) List all the bony injuries that you can see. (2 marks)

b) Other than fractures, what significant orthopaedic injury is likely to be present? (1 mark)

A 13-year-old boy, inversion injury foot, painful lateral border. Partially weight-bearing.

a) What is shown on the x-ray? Is this normal or abnormal? (2 marks)

b) What is the management of fractures of the base of the 5th metatarsal? (1 mark)

A 22-year-old woman stubbed her 4th toe against a doorframe and possibly dislocated it.

a) What is the injury? (1 mark)

b) What is the management in the Emergency Department? (2 marks)

A 54-year-old woman with an inversion injury to her left foot. Tender lateral border of foot.

a) What injury is present? (1 mark)

b) What is the ED management of this injury? (2 marks)

A 12-year-old girl with a 1 week history of pain in her right foot after a 5 mile run. Tender over 2nd metatarsal.

a) What is the abnormality on the x-ray? (1 mark)

b) How should this be treated? (2 marks)

A 53 year old man who fell from his horse catching his left foot in the stirrup. Non weight-bearing. Tender and very swollen over entire dorsum of foot.

a) List all the injuries shown (2 marks)

b) How you determine whether a Lisfranc injury is present? (1 mark)

A 28 year old man who dropped a set of weights on his toes in the gym. Abrasions and tender over dorsal aspect of 1st and 2nd toes.

a) What abnormality(ies) is/are present? (1 mark)
B) What is the ED management? (2 marks)

A 48 year old homeless man with a crush injury to his big toe some weeks ago. Wound has not healed. He has cellulitis tracking over dorsum of foot.

a) What abnormality(ies) is/are shown on the x-ray? What is the radiographic diagnosis? (1 mark)

b) what further investigations would you carry out in the ED? (1 mark).

c) What further investigations would be carried (by Speciality teams) out to prove the diagnosis? (1 mark)

A 52 year old lady who fell off a stepladder. Pain & swelling over forefoot. Tender on squeezing metatarsal heads. Weight-bearing through her heel.

a) What injury(ies) is/are shown? (1 mark)

b) what is the management of this injury in the ED? (1 mark)

A 14 year old girl with several weeks of intermittent discomfort in both feet, especially the right. Aggravated by wearing high heels. Tender and swollen over 2nd metatarsal.

a) What is/are the abnormality(ies) on the x-ray? (1 mark)

b) What is the diagnosis? (1 mark)

c) What is the management in the ED? (1 mark)