How to Identify Unstable Lisfranc Injuries? Review of Diagnostic Strategies and Algorithm Proposal

Area of Science:

• Orthopedic Surgery
• Radiology
• Sports Medicine

Background:

• Lisfranc injuries are frequently misdiagnosed, with up to 50% of cases missed.
• Subtle or incomplete Lisfranc lesions pose significant diagnostic challenges.
• Conventional radiographs can fail to detect up to 30% of unstable injuries.

Purpose of the Study:

• To highlight the diagnostic challenges in Lisfranc injuries.
• To review the utility of various imaging modalities for detecting Lisfranc injuries.
• To emphasize the importance of accurate diagnosis for patient outcomes.

Main Methods:

• Review of conventional radiography (non-weight-bearing).
• Evaluation of advanced imaging techniques: abduction stress radiographs, weight-bearing radiographic views, computed tomography (CT), and magnetic resonance imaging (MRI).
• Discussion of diagnostic accuracy and limitations of each modality.

Main Results:

• Conventional radiographs have a high miss rate for unstable Lisfranc injuries.
• Abduction stress and weight-bearing radiographic views are effective for identifying instability.
• CT provides detailed fracture information, while MRI can predict instability but is less accessible acutely.

Conclusions:

• Early and accurate diagnosis of Lisfranc injuries is essential to prevent long-term complications.
• Advanced imaging techniques are vital for diagnosing subtle or unstable Lisfranc injuries.
• A multimodal imaging approach may be necessary for optimal diagnosis and management.