See the offset of the base of the 2nd MT in reference to the middle cuneiform and the widening of the space between the base of the 2nd MT and the medial cuneiform? This can and has been missed in the past. There are also fragments in the region of the abnormality reflecting fracture. This is a Lisfranc fracture dislocation. There is also a fracture of the base of the 4th MT that is present as well as a small fracture of the lateral distal cuboid. Remember- when there is one abnormality do not get hung up on it. You need to keep looking for more.
This is a serious fracture dislocation and if missed, will lead to serious problems. Therefore, always look at the Lisfrac interval between the base of the 2nd MT and Medial Cuneiform when reading foot x-rays.
Remember: “The Eyes Will Not See What the Brain Does Not Know”.