Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes.

Preidler, Klaus W.; Peicha, Geroif; Lajtai, G.; Seibert, F. J.; Fock, Christian M.; Szolar, Dieter M.; Raith, Hans

doi:10.2214/ajr.173.6.10584818

Cited by 109 publications

(72 citation statements)

References 10 publications

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“…8,[10][11][12] An indirect mechanism of injury has, however, also been implicated. 5,7,[13][14][15] This usually occurs in sports injuries or simple falls or sprains. Although rare, these injuries may cause considerable disability if they remain undiagnosed or are not properly treated.…”

Section: Discussionmentioning

confidence: 99%

The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation

Peicha¹,

Labovitz²,

Seibert³

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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T he anatomy of the mortise of the Lisfranc joint between the medial and lateral cuneiforms was studied in detail, with particular reference to features which may predispose to injury.In 33 consecutive patients with Lisfranc injuries we measured, from conventional radiographs, the medial depth of the mortise (A), the lateral depth (B) and the length of the second metatarsal (C). MRI was used to confirm the diagnosis. We calculated the mean depth of the mortise (A+B)/2, and the variables of the lever arm as follows: C/A, C/B and C/mean depth. The data were compared with those obtained in 84 cadaver feet with no previous injury of the Lisfranc joint complex. Statistical analysis used Student's two-sample t-test at the 5% error level and forward stepwise logistic regression.The mean medial depth of the mortise was found to be significantly less in patients with Lisfranc injuries than in the control group. Stepwise logistic regression identified only this depth as a significant risk factor for Lisfranc injuries. The odds of being in the injury group is 0.52 (approximately half) that of being a control if the medial depth of the mortise is increased by 1 mm, after adjusting for the other variables in the model. Our findings show that the mortise in patients with injuries to the Lisfranc joint is shallower than in the control group and the shallower it is the greater is the risk of injury. The tarsometatarsal joint of the foot (Lisfranc joint) consists of the distal row of tarsal bones, the medial, intermediate, and lateral cuneiforms and the cuboid, which articulate with the bases of the five metatarsals. It is Sshaped and is divided into three columns, with three distinct arches.1,2 Of the three arches, the horizontal arch is anchored by the base of the second metatarsal, which is recessed into a 'mortise' between the medial and lateral cuneiforms (Fig. 1), and stabilises the joint. 2,3Intermetatarsal and thin dorsal ligaments connect the second, third, fourth and fifth metatarsals, and the tarsometatarsal joint is further stabilised by the strongest of the ligamentous structures, the plantar tarsometatarsal ligaments. There is no intermetatarsal ligament between the bases of the first and second metatarsals. The main stabilising structure of the tarsometatarsal joint is a Y-shaped interosseous ligament (Lisfranc's ligament). This extends on the plantar surface from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second Fig. 1 Anatomical specimen of a left foot. It was dissected in an oblique axial plane showing the position of the second metatarsal base in the mortise between the medial and lateral cuneiform.

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Section: Discussionmentioning

confidence: 99%

The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation

Peicha¹,

Labovitz²,

Seibert³

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…MRI has generally been recognized as the modality of choice for identifying occult fractures; the other diagnostic modalities have been advocated less frequently. 1 In 49 patients with hyperflexion injuries of the foot investigated by Preidler et al, 7 radiographs revealed only 20 tarsal fractures and CT, 41 tarsal fractures, whereas MRI showed 39 tarsal fractures and 9 bone bruises (on CT, 2 of those bone bruises were in fact fractures). The use of bone scintigraphy has also been advocated, but in an anatomically complex region such as the midfoot, it is difficult to determine the exact site of uptake of the radionuclide and thus to identify the fracture site.…”

Section: Discussionmentioning

confidence: 98%

“…Less frequent is the stress type of fracture, 3 although these have been reported in both toddlers 4,5 and adults. 3,6 Imaging modalities that have been used to evaluate the cuboid bone include radiography, CT, 6,7 bone scintigraphy, 3,4,8 MRI, 9,10 and, more recently, sonography. 11 As already mentioned, plain radiography may miss fractures in the foot and ankle.…”

Section: Discussionmentioning

confidence: 99%

Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs

Enns

Pavlidis

Stahl

et al. 2004

J of Clinical Ultrasound

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We report the case of an isolated cuboid bone fracture in a child that was missed on radiography but was diagnosed on sonography. Plain radiographs of the patient's right foot showed no fracture, whereas sonograms demonstrated a fracture of the cuboid bone that appeared as a steplike discontinuity in the cortical bone. The diagnosis was confirmed on MRI. The fracture was treated with cast immobilization and no weight bearing for 4 weeks. In 8 weeks, the patient had no symptoms and good motor and sensory function of her right foot. Other imaging modalities are usually advocated for diagnosing fractures that are missed by radiography. Over the last decade, sonography has been increasingly used for diagnosing occult fractures. Although its use in such cases is not yet fully established, we believe that in the future, the sonographic detection of an injury that corresponds to the site of the reported pain will be adequate for initiating treatment of many types of fractures.

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“…Axial CT images better demonstrate the displacement, rotation, and integrity of the articular surfaces (Castagno et al 1987, Kilcoyne et al 1990). Axial CT scans are also superior to plain images in assessing the sizes of bony defects of the glenoid rim (Itoi et al 2003) Single-slice SCT with true axial and coronal images is effective in assessing complex fractures of the distal tibia, talus, calcaneus, and tarsometatarsal joint (Magid et al 1990, Janzen et al 1992, Wechsler et al 1997, Preidler et al 1999. However, in intraarticular calcaneal fractures the degree of depression of the posterior calcaneal facet may often be underestimated in lateral radiographs and also in coronal CT images (Rosenberg et al 1987, Ebraheim et al 1996.…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

“…Due to the high-energy injury mechanism, many patients also had additional foot and ankle fractures and severe injuries to other parts of the body. In a Lisfranc fracture-dislocation, the fracture lines and minimal tarsometatarsal malalignment are sometimes difficult to detect in conventional radiographs (Foster and Foster 1976, Norfray et al 1981, Faciszewski et al 1990, Lu et al 1997, Preidler et al 1999. It has been estimated that as many as 20% of Lisfranc joint injuries are missed on initial AP and oblique radiographs (Mantas and Burks 1994, Englanoff et al 1995, Trevino and Kodros 1995.…”

Section: Ankle and Footmentioning

confidence: 99%

Multidetector computed tomography in acute joint fractures

Haapamäki

Kiuru²,

Mustonen³

et al. 2005

Acta Radiol

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Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.

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Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes.

Cited by 109 publications

References 10 publications

The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation

The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation

Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs

Multidetector computed tomography in acute joint fractures

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