The missed chapter on midfoot: Chopart injuries

Area of Science:

• Orthopedics
• Radiology
• Medical Imaging

Background:

• Midtarsal injuries are frequently overlooked during initial assessment, potentially leading to chronic complications.
• Radiographs (XR) are the standard initial imaging modality for traumatic ankle and foot injuries (TAAFI).
• The role of cone beam computed tomography (CBCT) in evaluating midfoot injuries requires further clarification.

Purpose of the Study:

• To update imaging findings for traumatic ankle and foot injuries (TAAFI) using CBCT.
• To evaluate the diagnostic performance of XR compared to CBCT for detecting midfoot injuries.

Main Methods:

• A retrospective analysis of 754 CBCT studies performed for TAAFI over five years, all of which had prior XR imaging.
• Anonymized CBCT scans were analyzed by one radiologist.
• A second radiologist performed a blinded, retrospective analysis of the corresponding XR images as a control.

Main Results:

• Chopart injuries were identified in 20.4% and Lisfranc injuries in 20.2% of patients.
• XR demonstrated a sensitivity of 64.9% for Chopart's injuries and 62.1% for Lisfranc injuries.
• XR showed high specificity (95.0% for Chopart's, 99.0% for Lisfranc's) but lower sensitivity, indicating a significant rate of missed midfoot injuries.

Conclusions:

• This study underscores the limitations of XR in detecting Chopart injuries and their infrequent association with Lisfranc avulsions.
• CBCT is a valuable tool for the accurate detection and assessment of midfoot injuries.
• The findings suggest that CBCT should be considered in the management of suspected midfoot trauma when initial XR is inconclusive.