Diagnosis

Intertarsal crush injuries

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 Intertarsal injuries
 History and physical exam
 Imaging
Intertarsal injuries

Intertarsal injury is an injury to the area bounded by the Lisfranc region distally and the Chopart region proximally. It may involve the navicular-cuneiform or intercuneiform joints of the midfoot, or the cuneiform bones.


History and physical exam

These injuries may arise in athletics and be very subtle, or they may be the result of higher-energy injury and be more obvious. Their mechanism is similar to a Lisfranc midfoot injury or a similar twist, and they may indeed be part of a Lisfranc fracture dislocation.
The high-energy injury is often part of a polytrauma and is often associated with other injuries, in the foot and other parts of the body.
In the multiply-injured patient, intertarsal injuries and fractures may be picked up on the secondary survey. In the case of unconscious patients, care should be taken to check for unusual swelling, crepitus and/or deformity. If suspected, foot x-rays are indicated.
This x-ray shows a severe injury of the foot with complete disorganization of the anatomy.


High-energy injuries are often associated with other injuries, both in the foot and the rest of the body.
In the event of severe soft-tissue injury, possibly with vascular compromise, or co-morbidities (diabetes, etc.), external fixation may be the only treatment choice available, at least in the short term. Much later, reconstruction may be possible.
This clinical photograph shows a severe open fracture.


Imaging

Plain x-rays will often show the injury pattern.
CT with sagittal and coronal reconstruction is useful in obtaining a three-dimensional understanding of the injury. CT protocol should be thin cuts with large overlap.