UMEM Educational Pearls

Category: Orthopedics

Title: Imaging of Lisfranc Injuries

Keywords: foot fracture, radiology (PubMed Search)

Posted: 9/14/2019 by Brian Corwell, MD (Updated: 4/19/2024)
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Imaging of Lisfranc Injuries

Tarsometatarsal fracture-dislocation

Anatomy

3 Columns of the midfoot, divided by the tarsometatarsal joints

The Lisfranc ligament

- Extends from the 2^nd MT to the medial cuneiform

- Critical to structure and stabilization of the 2^nd MT and the midfoot arch

Imaging

Plain films: AP/lateral/oblique

Consider weight bearing view with contralateral comparison if high suspicion

CT: Can be useful to confirm abnormal plain films

MRI: not done in ED but can be used to diagnose pure ligament injuries

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.

On AP view:

Discontinuity of a line drawn from the medial part of 2^nd MT to the medial side of the 2^nd cuneiform
Widening of the interval between the 1^st and 2^nd ray
Bony fragment in 1^st MT space (fleck sign) – Lisfranc ligament avulsion

On Lateral view:

On the Oblique view:

Discontinuity of a line drawn from the medial border of the 3^rd cuneiform with the medial border of the 3^rd MT
Discontinuity of a line drawn from the medial side of the 4th MT with the medial side of the cuboid

Remember that the lateral margin of the 5^th MT can project lateral to the cuboid (up to 3 mm)

Lines drawn on 2 view foot for review

Orthobullets.org