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Further to the case report presented by Carter and Wilby (Emerg Med J 2000 17:387) where a valuable lesson is demonstrated regarding overlooking lisfranc fractures in the presence of polytrauma, we would like to add to this a patient we encountered in order to emphasize the point.
A 27-year-old male was admitted following a road traffic accident where the patient riding a motorcycle collided with a car...
A 27-year-old male was admitted following a road traffic accident where the patient riding a motorcycle collided with a car at high speed. His obvious injury was a fractured right femur, which was grossly angulated at the level of the midshaft. He also had a cold cyanotic forefoot on the same side with an absent Dorsalis Pedis pulse on doppler examination. Femoral artery damage was suspected and an angiogram was therefore performed which demonstrated a normal vascular tree.
Radiographs of the foot, which was relatively painless, demonstrated a lisfranc fracture, which was openly reduced and internally fixed following intra-medullary nailing of the femur. During open reduction the vascularity of the foot which was now swollen and tense rapidly improved. We believe this represented a compartment syndrome in the foot secondary to the lisfranc fracture.
To reinforce the original point made by Carter and Wilby, this lisfranc fracture could have been overlooked whilst attention was being paid to the more painful injury, in this case the fractured femur and concerns regarding femoral artery damage. We would therefore like to reiterate that in a case of major trauma foot injuries might be overlooked unless a detailed secondary survey is performed to exclude them.
Nick W Emms