[image: 21m crush inj 3rd MT fx PTT insertion.jpg]
In Sag images I see the main slip of the PTT inserting onto the plantar
base of the Med Cuneiform, but I never see it insert onto the Navicular.
I wonder if this is a delaminating tear at the medial pole navicular, or if
it’s uninjured and it’s a normal variant insertion.
(There’s a plantar 1st TMT capsular sprain…fyi, Lisfranc ligament complex
is uninjured)
[image: 21m crush inj 3rd MT fx PTT insertion (1).jpg]
More images from medial to lateral…the accessory slips are thick and
bright but there’s no focal tear
[image: 21m crush inj 3rd MT fx PTT insertion (2).jpg]
Red arrows point to accessory slips of PTT
[image: 21m crush inj 3rd MT fx PTT insertion (3).jpg]
White arrow points to PTT main slip passing under but not inserting onto
medial navicular…..looks smooth, but there is some bright signal between
tendon and bone.
[image: 21m crush inj 3rd MT fx PTT insertion (4).jpg]
Red arrow points to accessory slips of PTT
[image: 21m crush inj 3rd MT fx PTT insertion (5).jpg]
You can partially see the intra articular fracture of the 3rd MT base and
the contusion of the medial cuneiform.
CT same date shows the 3rd MT fracture only.
