Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited

The purpose of this article is to discuss the features of Lisfranc injuries and identify their typical imaging findings on radiographs, CT, and MR imaging. Lisfranc injuries are most often caused by hyperplantarflexion of the foot, often during a sporting injury or in high-speed motor vehicle collisions. The most common radiographic findings include diastasis of the base of the first and second metatarsals and the "fleck" sign, though neither is necessarily present in every Lisfranc fracture-dislocation. Owing to their often subtle radiographic presentation, clinically suspected Lisfranc injuries warrant imaging with a more sensitive test for the detection of osseous and ligamentous Lisfranc injuries. 3D CT imaging provides a comprehensive evaluation of the injury for optimal treatment planning, with resultant decreased long-term patient morbidity. Furthermore, 3D volume-rendered CT and CT multiplanar reconstructions (MPRs) provide osseous and neurovascular anatomic detail that may be a considerable help with surgical planning for operative cases of Lisfranc injuries. Also, with 3D CT and MPRs, other occult fractures, which are common in patients with high-energy injury and multiple trauma, may become evident.