The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection

Rankine, James J.; Nicholas, Chris M.; Wells, Gareth; Barron, Dominic A.

Affiliations

¹Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK

²Radiology Department, Leeds General Infirmary, B Floor, Clarendon Wing, Leeds, West Yorkshire, LS1 3EX, UK

³Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK

Abstract and keywords

Objective: The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. In addition, a foot phantom was investigated to determine the optimum degree of craniocaudal angulation on the anteroposterior radiograph to best show the joint. The angle of the joint in patients with midfoot injury was investigated to determine the optimum degree of craniocaudal angulation.

Materials and Methods: Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. This was compared with the angle of the joint as measured on CT. The angle of the joint in all 60 patients was measured on CT.

Results: The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. Twenty degrees of craniocaudal angulation best showed the second tarsal-metatarsal joint of the phantom, and this correlated with a 20° angle measured by CT. The mean (± SD) angle of the joint in the patients was 28.9° ± 5.7°.

Conclusion: Conventional radiographs miss a significant number of cases of Lisfranc injury. Craniocaudal angulation can better show the joint, and an angle of 28.9° is likely to optimally visualize the joint in the majority of patients.

Keywords: CT; diagnostic accuracy; Lisfranc injury; radiography; trauma

Links

DOI: 10.2214/AJR.11.7222

PubMed: 22451574

History

Received: 2011-05-16

Accepted: 2011-08-12

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2024	McDermott A, Repanshek Z, Koyfman A, Long B. High risk and low incidence diseases: Lisfranc injury. Am J Emerg Med. November 2024;85:172-178.
2017	Goyal N, Patil S, Patil A, Shingane V. Study of Lisfranc fracture: rare fracture of foot. Indian J Appl Res. June 2017;7(6):49-50.
2015	Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury. April 2015;46(4):536-541.
2022	De Bruijn J, Hagemeijer NC, Rikken QGH, Husseini JS, Saengsin J, Kerkhoffs GMMJ, Waryasz G, Guss D, DiGiovanni CW. Lisfranc injury: refined diagnostic methodology using weightbearing and non-weightbearing radiographs. Injury. June 2022;53(6):2318-2325.
2014	Elgazzar A, Omar A, Al Feeli M, Owunwanne A, Al-Sayad A. Bone scintigraphy in the diagnosis of Lisfranc fracture. Int J Orthop. 2014;1(4):160-163.
2014	Salvi AE. Lisfranc injuries: a matter of ligament disruption. J Foot Ankle Surg. September–October 2014;53(5):674-676.
2015	Libby B, Ersoy H, Pomeranz SJ. Imaging of the Lisfranc injury. J Surg Orthop Adv. Spring 2015;24(1):79-82.
2013	Eleftheriou KI, Rosenfeld PF, Calder JDF. Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc. June 2013;21(6):1434-1446.
2018	Aboueddahab Z. Les fractures luxations de Lisfranc: Etude retrospective d’une serie de 10 cas [Lisfranc Fracture-Dislocation: Retrospective Study of 10 Cases] Mohammed V University; 2018.