ARRS 2022 Abstracts

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E1637. One Foot in the ER: A Review of Foot Fracture Anatomy and Pathology
Authors
  1. Stefan Brancel; Henry Ford Hospital
  2. Mackenzie Szczepanski; Idaho College of Osteopathic Medicine
  3. Chad Klochko; Henry Ford Hospital
  4. Joseph Craig; Henry Ford Hospital
Background
Foot fractures are relatively common occurring in 142 per 100,000 per year. Patients who present with foot pain to the emergency room should have foot radiographs as initial imaging evaluation. The overlapping nature of the osseous structures in the foot and importance of supporting ligamentous structures that are not visualized on radiographs can make appropriate diagnosis difficult. Many fractures in the foot can have long lasting and severe adverse effects if not correctly identified. Understanding the complex osseous, ligamentous, and tendonous anatomy in the foot is critical to both identify pathology correctly and to correctly recommend additional imaging.

Educational Goals / Teaching Points
The goals for this exhibit are to review key normal anatomy in the foot, with an emphasis on fracture-related structures on radiographs and cross-sectional imaging; present examples of fractures that are easily missed and/or can have serious adverse effected when not identified with correlation between radiographs and cross-sectional imaging to better display the underlying anatomy; and define each fracture type, discuss the mechanistic etiologies, and identify complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal anatomy is reviewed by presenting normal radiographs showing key anatomy including the Lis Franc joint, anterior calcaneal process, Chopart joint, sustentaculum tali, and flexor and peroneal tendon attachments. To further awareness of how these structures are inter-related in 3D, we show companion cross-sectional imaging. Cases of Lis Franc fracture, Chopart joint dislocation, Jones fracture, pseudo-Jones fracture, posterior talar process fracture, calcaneal body fracture, avulsion fracture of the talonavicular capsule, and avulsion fracture of the origin of the extensor digitorum brevis are shown with CT or MRI correlates when appropriate.

Conclusion
Foot fractures are frequently encountered in the emergency room. An in depth understanding of the normal anatomy of the foot in combination with a familiarity of fractures that can produce high morbidity when missed can help radiologists accurately identify them quickly to improve patient outcomes.