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Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI.

Methods

We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed.

Results

Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P ≤ 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane.

Conclusion

Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance.

Level of evidence

Case control study; III.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea

    Dong Woo Shim, Sung Chul Shin & Seung-Yong Sung

  2. Student, Catholic Kwandong University College of Medicine, 7, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea

    Eunyoung Choi

  3. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea

    Young-Chang Park

  4. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Jin Woo Lee

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  1. Dong Woo Shim
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Contributions

Conceptualization: DWS. Data curation: EC, DWS, SCS. Formal analysis: S-YS, JWL. Funding acquisition: N/A. Investigation: DWS, EC, Y-CP, SCS. Methodology: S-YS, JWL. Project administration: JWL, Y-CP. Resources: EC, DWS, SCS. Software: DWS, Y-CP. Supervision: JWL. Validation: Y-CP, S-YS. Visualization: DWS, JWL, S-YS. Writing—original draft: DWS. Writing—review and editing: S-YS.

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Correspondence to Seung-Yong Sung.

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This study was approved by the Catholic Kwandong University International St. Mary’s Institutional Review Board (IS20RISI0058).

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Shim, D.W., Choi, E., Park, YC. et al. Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury. Arch Orthop Trauma Surg 142, 3705–3714 (2022). https://doi.org/10.1007/s00402-021-04182-7

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