Title: Imaging of Lisfranc Injuries<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
        <span style="font-size:14px;"><strong>Imaging of Lisfranc Injuries</strong></span></p>
<p>
        <strong>Tarsometatarsal fracture-dislocation</strong></p>
<p>
        <strong>Anatomy</strong></p>
<p>
                 <strong>3 Columns of the midfoot, divided by the tarsometatarsal joints</strong></p>
<ol>
        <li>
                <strong>Medial</strong>
                <ol style="list-style-type:lower-alpha;">
                        <li>
                                <strong>First TMT joint</strong></li>
                </ol>
        </li>
        <li>
                <strong>Middle</strong>
                <ol style="list-style-type:lower-alpha;">
                        <li>
                                <strong>2^nd and 3^rd TMT joints</strong></li>
                </ol>
        </li>
        <li>
                <strong>Lateral </strong>
                <ol style="list-style-type:lower-alpha;">
                        <li>
                                <strong>4^th and 5^th TMT joints</strong></li>
                </ol>
        </li>
</ol>
<p>
        <strong>The Lisfranc ligament </strong></p>
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        <strong>     - Extends from the 2^nd MT to the medial cuneiform</strong></p>
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        <strong>     - Critical to structure and stabilization of the 2^nd MT and the midfoot arch</strong></p>
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         </p>
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        <strong>Imaging </strong></p>
<p>
        Plain films: AP/lateral/oblique</p>
<p>
        Consider weight bearing view with contralateral comparison if high suspicion</p>
<p>
        CT: Can be useful to confirm abnormal plain films</p>
<p>
        MRI: not done in ED but can be used to diagnose pure ligament injuries</p>
<p>
        Below is a review of the lines of the foot which will ensure not missing this diagnosis. May be helpful to review with sample imaging.</p>
<p>
        <strong>Plain films findings: <a href="https://prod-images.static.radiopaedia.org/images/49189279/86408d5bae08ab80ae9ef377337ab7_big_gallery.jpeg">https://prod-images.static.radiopaedia.org/images/49189279/86408d5bae08ab80ae9ef377337ab7_big_gallery.jpeg</a></strong></p>
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         </p>
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        <strong>On AP view:</strong></p>
<ol>
        <li>
                Discontinuity of a line drawn from the medial part of 2^nd MT to the medial side of the 2^nd cuneiform</li>
        <li>
                Widening of the interval between the 1^st and 2^nd ray</li>
        <li>
                Bony fragment in 1^st MT space (fleck sign) – Lisfranc ligament avulsion</li>
</ol>
<p>
        <strong>On Lateral view: </strong></p>
<ol>
        <li>
                Dorsal displacement of the proximal 1^st or 2^nd MT (may be subtle)</li>
</ol>
<p>
        <strong>On the Oblique view:</strong></p>
<ol>
        <li>
                Discontinuity of a line drawn from the medial border of the 3^rd cuneiform with the medial border of the 3^rd MT</li>
        <li>
                Discontinuity of a line drawn from the medial side of the 4th MT with the medial side of the cuboid </li>
</ol>
<p style="margin-left:.75in;">
        <strong>Remember that the lateral margin of the 5^th MT can project lateral to the cuboid (up to 3 mm)</strong></p>
<p style="margin-left:.75in;">
         </p>
<p style="margin-left:.75in;">
        <strong>Lines drawn on 2 view foot for review</strong></p>
<p style="margin-left:.75in;">
        <a href="https://radiopaedia.org/cases/lisfranc-ligament-normal-alignment">https://radiopaedia.org/cases/lisfranc-ligament-normal-alignment</a></p>
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         </p>
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         </p>
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         </p>
<fieldset><legend>References</legend>

                <p>
        <a href="https://radiopaedia.org/">https://radiopaedia.org</a></p>
<p>
        Orthobullets.org</p>
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