FIGURE 111.55 Lisfranc fracture, with acute fractures of the second and third metatarsals with widening of the Lisfranc interval (arrow ) (Reprinted with permission from Bridgeforth GM Lippincott’s Primary Care Musculoskeletal Radiology Philadelphia, PA: Lippincott Williams & Wilkins; 2010.) INJURIES OF THE THORACOLUMBAR SPINE Goals of Treatment Injuries to the thoracolumbar spine are uncommon in children as a result of their anatomy and the biomechanics of the growing spine; however, they represent the potential for significant morbidity An understanding of the mechanisms and energy level most likely to cause injury, as well as the key examination findings indicative of thoracolumbar injury, can prevent further incidental morbidity during evaluation in the ED In general, any child with significant head or multisystem trauma should be assumed to have a spinal injury until proven otherwise Diagnosis of a spinal injury in the child with a severe brain injury can be particularly problematic given that these patients are often sedated and/or