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Computed Tomography

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Tomography refers to imaging by sections. Computed tomography (CT) is a non-invasive imaging technique that uses computers to analyze several cross-sectional X-rays to reveal minute details about structures in the body.
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Weightbearing Computed Tomography Can Accurately Detect Subtle Lisfranc Injury.

Rohan Bhimani^1,2,3, J Daniel Thompson², Nina Suh²

¹Foot & Ankle Service, Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA.

Foot & Ankle International

|July 31, 2024

Summary

Weightbearing computed tomography (WBCT) improves detection of subtle Lisfranc injuries. The C1-M2 distance measurement on WBCT showed the highest accuracy in diagnosing these injuries, aiding early intervention and better patient outcomes.

Keywords:

Lisfranc Lisfranc joint injury instability tarsometatarsal joint weightbearing computed tomography

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Area of Science:

Orthopedic imaging
Foot and ankle surgery
Radiology

Background:

Early detection of Lisfranc injury is crucial for optimal clinical outcomes.
Diagnosing subtle Lisfranc injuries can be challenging with conventional imaging.
Weightbearing computed tomography (WBCT) offers 3D evaluation under physiologic load.

Purpose of the Study:

To assess the diagnostic utility of 1D, 2D, and 3D measurements on WBCT for subtle Lisfranc injuries.
To compare the accuracy of various WBCT measurements in identifying Lisfranc joint complex injuries.
To determine the most effective WBCT metrics for diagnosing subtle ligamentous Lisfranc injuries.

Main Methods:

Ten cadaveric specimens were analyzed using WBCT.
Lisfranc joint complex was evaluated in intact state and after sequential ligamentous injury.
Multiple 1D, 2D, and 3D measurements of the Lisfranc joint were taken under 80kg load.

Main Results:

WBCT measurements including Lisfranc joint volume, area, C1-M2 distance, and M1-M2 distance significantly increased in subtle injury states.
C1-M2 distance demonstrated the highest diagnostic accuracy (AUC=0.96, 90% sensitivity, 90% specificity).
Lisfranc joint volume (AUC=0.90) and area (AUC=0.89) also showed high accuracy in detecting injuries.

Conclusions:

WBCT enhances diagnostic accuracy for subtle Lisfranc injuries in a cadaveric model.
C1-M2 distance, 2D joint area, and 3D joint volume are accurate metrics for diagnosing Lisfranc injuries.
3D joint volume showed the most significant absolute difference with increasing injury severity, suggesting its potential as a supplementary diagnostic tool.