Dr. Chitrangada Jitendra
Radiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
One week ago I have slipped when walking, fell after hitting the curb, and landed on my right foot in an awkward position from small altitude. I was able to walk with minor to moderate pain, and visited the nearest trauma center in an hour, got an X-ray and cast immobilization, and was diagnosed with fractures in second and third metatarsals. I was told to take antithrombotic medications, avoid putting any load on the feet, and basically, that was all. The feet itself did not hurt for the whole week afterward. Today, I visited a different clinic for a check-up, got another X-ray and a different diagnosis (no fracture in the third metatarsal, but a fracture in cuneiform bone). So, I would like to ask to take a look at DICOM X-ray data from the second clinic and check what bones actually have fractures (because I am quite anxious that something could have been missed), and if there are any indications of recovery. Currently, I am taking delayed-release Acetylsalicylic acid as an antithrombotic, Calcium and D3 Vitamin supplements.
Hi,
Welcome to icliniq.com.
Your radiographs (attachment removed to protect patient identity) do not show any meta-tarsal fracture. However, a medical cuneiform fracture is seen. Probably it could be a Lisfranc injury. An orthopedic consultation is advisable as you would require casting to stabilize the joint. Else you may end up having chronic foot pain due to the resultant altered alignment of foot bones. Take care.
For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist
Patient's Query
Hi doctor,
Thanks for a quick answer. So the medial cuneiform is the only bone broken? How serious is such a fracture? Currently, I have a cast immobilization applied. How much time would be needed (on average) for healing?
Hello,
Welcome back to icliniq.com.
The medial cuneiform is fractured. However, there is a doubtful fracture of the base of second metatarsal bone also. There is no fracture of the base of the third metatarsal. Basically, these fractures happen when there is an injury to the Lisfranc ligament which is attached between the medial cuneiform and the base of second metatarsal bone. The further treatment which I have discussed with an orthopedic surgeon here is to get another X-ray done a lateral view of the affected foot. This will show the amount of displacement of the joint. This is considered a highly unstable fracture. So, lateral view of X-ray is recommended. If there is doubt in the displacement of the fracture in the lateral view of X-rays, then you will require a CT scan. Prognosis depends upon the amount of displacement of the fractured bone and joint.
For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist
Probable diagnosis
Treatment plan
Patient's Query
Hi doctor,
Thank you so much for the response.
Hello,
Welcome back to icliniq.com.
You are welcome.
For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist
Patient's Query
Thank you doctor,
I am planning to do a lateral X-ray scan tomorrow. Would a CT scan be an option, too? Also, here is a photo of a lateral X-ray scan from the first clinic.
Hello,
Welcome back to icliniq.com.
This lateral X-ray is fine. It would be wise to repeat it. Anyways check for displacement and then follow up. If it stays the same, then cast immobilization will be enough. But will take a look at your next lateral X-ray and then decide. CT scan is not necessary if you can get a good lateral X-ray as it does not look much displaced.
For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist
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Radiology
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