Rethinking the Lisfranc injury: Rationale for and development of a new classification system for Lisfranc injuries

Area of Science:

• Orthopaedic surgery
• Traumatology
• Radiology

Background:

• Lisfranc joint injuries are complex and often misdiagnosed, leading to poor outcomes.
• Current classification systems like Myerson-Hardcastle (MHC) lack clinical utility and do not account for force propagation.
• Standardizing management and prognostication for Lisfranc injuries remains a challenge.

Purpose of the Study:

• To develop and validate a new classification system for Lisfranc injuries.
• To assess the inter- and intra-observer reliability of the new Suthersan classification.
• To compare the reliability of the Suthersan classification against the existing MHC system.

Main Methods:

• A new classification system, the Suthersan classification, was developed.
• 176 indirect Lisfranc injuries were analyzed from a single-surgeon case series.
• Radiographs were reviewed by three surgeons using both Suthersan and MHC classifications; reliability was assessed using Cohen's Kappa statistic.

Main Results:

• The Suthersan classification showed excellent inter-rater reliability (0.95) and intra-rater agreement (97.7%).
• The MHC classification demonstrated lower inter-rater reliability (0.65) and intra-rater agreement (87.9%).
• 19 CT scans were unclassifiable using the MHC system.

Conclusions:

• The Suthersan classification exhibits superior inter- and intra-rater agreement compared to the MHC classification.
• The Suthersan classification's consideration of force propagation may enhance prognostication and management algorithms.
• Further prospective studies are needed to correlate Suthersan categories with clinical outcomes.