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E1361. The Mysterious Midfoot: Identifying, Classifying, and Treating Midfoot Fractures
Authors
  1. Joshua Gu; McGovern Medical School
  2. Nicholas Beckmann; McGovern Medical School
Background
The midfoot is comprised of five bones: the navicular, cuboid, and 3 cuneiforms. Fractures of the midfoot are rare, usually occurring as part of larger fracture patterns in the setting of high energy trauma. Due to their rarity, few radiologists have a firm understanding of common presentations of midfoot fracture or of the imaging findings that influence fracture management. This presentation aims to educate viewers on the diagnosis and management of midfoot fractures in order to improve viewers’ detection and description of these injuries.

Educational Goals / Teaching Points
1. Describe midfoot anatomy 2. Discuss common fracture patterns of the midfoot 3. Differentiate midfoot fractures likely to require surgical fixation from fractures likely treated conservatively 4. Summarize key fracture characteristics that influence treatment

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Midfoot anatomy- Anatomy will be presented predominately using a combination of radiographs and 3D volume rendered CT images. Some MRI images will be used to demonstrate key insertion sites for ligaments and tendons. 2. Role of imaging- Brief discussion on indications for imaging midfoot trauma and the roles of radiographs, CT, and MRI. 3. Midfoot fractures- Each of the five midfoot bones will be discussed separately. Discussion will focus on common fracture patterns/locations, imaging indications for surgical stabilization, and imaging findings that require urgent surgical treatment. Commonly used classification systems (e.g. Sangeorzan classification of navicular fractures) will be included. Surgical fixation techniques with post-operative appearance of hardware and how to assess for post-operative complications will also be discussed. 4. Example cases of fractures- Presentation will conclude with example cases the viewer can take as unknowns. Each example case will be followed by a brief description of key imaging findings of the case that highlight the main teaching points of the exhibit.

Conclusion
Midfoot fractures are a rare but important injury to identify and treat. By viewing this presentation, radiologists will have a much better understanding of midfoot fractures and be able to better identify these injuries and describe them in a way that is clinically meaningful.