misdiagnosed lisfranc injury

All such injuries had been diagnosed according to the Faciszewski et al. criteria15. Injury. 2022. FOIA Y. Yang revised the manuscript. 2021;142(12):3705-14. Deluca MK, Walrod B, Boucher LC. CAS Rankine JJ, Nicholas CM, Wells G, Barron DA. Typical signs and symptoms include pain, swelling and the inability to bear weight. Conventional radiographical images comprised non-weight-bearing foot radiographs using anteroposterior, 30 oblique, and lateral views. ZhongMin Shi or YunFeng Yang. Panchbhavi, V. K., Vallurupalli, S., Yang, J. Nunley, J. Ly, T. V. & Coetzee, J. C. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Continuous variables are described as meanstandard deviation; qualitative variables are described as numbers and proportions. The site is secure. Based on this observation, new questions can be formulated: How do we reduce lapses in clinical decision-making processes? 1e), and longitudinal type, transverse type, and first TMT joint injury (n=2, 2%) (Fig. Federal government websites often end in .gov or .mil. Would you like email updates of new search results? J Bone Joint Surg Am. Despite the growing number of reports on the treatment of subtle Lisfranc injury2,8,13,15,17,18,19,21, a relatively small number of patients have been studied, and the actual pathological characteristics of subtle Lisfranc injury remain unclear. 8600 Rockville Pike government site. 2010 Dec;38(4):119-26. doi: 10.3810/psm.2010.12.1834. J Bone Joint Surg Am. The other 10 injuries had more significant bony malalignment and were graded according to the Hardcastle et al.22 system as 6 type B (partial incongruity) injuries and 4 type C (divergent, partial displacement) injuries. Imaging in Lisfranc injury: a systematic literature review. Subtle or incomplete lesions are the most problematic group for an adequate diagnosis. Ponkilainen VT, Laine HJ, Menp HM, Mattila VM, Haapasalo HH. In this study, we aimed to determine the diagnostic validity and reliability of conventional radiography in Lisfranc injury diagnosis using a large sample of consecutive patients. We also applied manual stress (abduction, adduction, or plantar flexion) to the foot to detect any joint instability. 2014 Dec;43(12):557-61. Three-column or displaced injuries had the highest possibility of being recognized. used three-dimensional volumetric measurements from weight-bearing CT to detect Lisfranc instability with a higher sensitivity (91.6%92.3%) and specificity (96.5%97.7%) than those detected using two- and one-dimensional measurements [24]. Kitsukawa K, Hirano T, Niki H, Tachizawa N, Nakajima Y, Hirata K. MR Imaging Evaluation of the Lisfranc Ligament in Cadaveric Feet and Patients With Acute to Chronic Lisfranc Injury. Phys Sportsmed. Early diagnosis is important in patients with Lisfranc joint injury to avoid subsequent complications. Br Med Bull. a-c The conventional radiographs showed no obvious fractures. Koroneos ZA, Manto KM, Martinazzi BJ, Stauch C, Bifano SM, Kunselman AR, Lewis GS, Aynardi M. Am J Sports Med. 3b). However, there is no guarantee of a perfect outcome; such injury can become a source of persistent disability and pain, the amount of which varies from patient to patient11,13. Lisfranc injuries can be managed operatively or non-operatively . Midfoot sprains in the National Football League. Curtis et al.2 described 3 injuries (out of a total 19 TMT joint injuries) as type B1 injuries but failed to describe the injury patterns in the other cases. Primary Arthrodesis for High-Energy Lisfranc Injuries. Referral to an orthopedic surgeon is appropriate for injuries that result in joint diastasis. 2020;39(3):57987. These classification systems deal mainly with fracture-dislocations of the Lisfranc joint complex and are not suitable for subtle Lisfranc injury. From that time onward, we obtained CT images for all patients presenting with what was considered a subtle Lisfranc injury. The site is secure. 8600 Rockville Pike Difficulties persist in the diagnosis and treatment of this injury type [7, 8], with clinical misdiagnosis and missed diagnoses often occurring.Patients with Lisfranc injuries receiving inappropriate treatment leads to chronic pain, high morbidity, and . Despite the observation of only minor radiographic changes, underlying soft tissue damage can be severe in some patients with subtle Lisfranc injury. Twenty-five percent of the total 82 patients had a concomitant first TMT joint injury, and 13% of the total patients (including 25% of the 44 patients with a longitudinal type injury) had a naviculo-first cuneiform joint injury. Currently, there is little information available on the actual pathological characteristics of subtle Lisfranc injuries. Unfortunately, if the Lisfranc injury is missed, it is generally accepted that the longer the delay in treating the injury, the worse the outcome can be and the patient may require surgery to fuse the midfoot which is a more major procedure than the surgery that would have been required with timely diagnosis. (f) Longitudinal type injury, transverse type injury, and first tarsometatarsal joint injury. Bookshelf Surgical outcome is not as good as in the case of an early reduction. Haapamaki VV, Kiuru MJ, Koskinen SK. The measurement of observer agreement for categorical data. 72, 151922 (1990). PubMed Some authors have suggested that subtle Lisfranc injury is caused by an isolated rupture of the Lisfranc ligament21. Arch Orthop Trauma Surg. What Are the Symptoms? The Lisfranc ligament is the strongest supportive structure of the TMT joint complex and has been considered to be the focal point of Lisfranc injuries. The majority of patients initially visit primary care doctors, which means that some radiographical methods are not available. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. One or more fractures were detected on CT images of 57 (78%) of the 73 patients for whom CT images had been obtained, despite the fact that no fractures were detected on the radiographs of these 57 patients. A Lisfranc injury occurs when one or more of the metatarsal bones are displaced from the tarsus, which is a cluster of bones at the top of the foot, just below the ankle joint. I have acted for several clients who, following an injury to their foot, have presented to an A&E department . Nunley JA, Vertullo CJ. Because orthopedic surgeons are becoming increasingly aware of the great potential for long-term disability resulting from subtle Lisfranc injury, foot injuries are being carefully screened and subtle Lisfranc injury is diagnosed with increasing frequency, particularly in sports participants16,18. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Many Lisfranc injuries are misdiagnosed as foot sprains. Subtle injuries of the Lisfranc joint. Lisfranc injuries appear rare and account for 0.2% of all fractures, with approximately 20% of cases remaining undiagnosed or diagnosed late . Magn Reson Imaging Clin N Am. Introduction: Among the 307 injuries, 84 (27.4%) were displaced and 223 (72.6%) were non-displaced. The mean for interobserver reliability was 0.69 and intra-observer reliability was 0.73, which resulted in a substantial correlation. a-b The Lisfranc injury was easily missed on plain X-ray. 2013 Oct;27(10):1196-201. Mascio A, Greco T, Maccauro G, Perisano C. Int J Physiol Pathophysiol Pharmacol. Ligaments hold these bones in place. In a transverse type injury, a joint between the third cuneiform and the third metatarsal (M3) may be involved. Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Our study used the largest data sample thus far reported, reflecting a complicated real-life situation with no manipulation of the proportion of Lisfranc injury subgroups. Panchbhavi, V. K., Andersen, C. R., Vallurupalli, S. & Yang, J. Accessibility Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan, Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital 4-22-1 Nakano, Nakanoku, Tokyo, 164-8541, Japan, Koki Ota,Takuma Ozeki&Shingo Nishizaka, You can also search for this author in The recognition rate reported in the literature varies from 68.9% to 86.0% [3, 12, 13, 31,32,33,34]. The CT was performed to screen for fracture and, when necessary, to assess the C1M2 distance. The Lisfranc (or Oblique) ligament secures the second metatarsal to the medial cuneiform, serving as a mortise joint anchoring the entire complex and preventing medio-lateral or plantar displacement. Lisfranc injuries mainly involve the tarsometatarsal joint complex [1] and are currently a trending topic in the field of foot trauma [2]. MeSH Frederick RI, Bowden SC. However, we applied the Faciszewski et al. Copyright 2020 Elsevier Inc. All rights reserved. The images or other third party material in this article are included in the articles Creative Commons license, unless indicated otherwise in a credit line to the material. Because various injury patterns are possible, no single model of Lisfranc joint injury, especially a modest injury model, can represent the full spectrum of injuries, and thus generalizability of the study results is limited. Read about Helen's recent settlement following delayed diagnosis at Bedford Hospital. A Lisfranc fracture dislocation involves injury to the bony and soft tissue structures of the tarsometatarsal joint. Coughlin, M, Saltzman, C, Anderson, R) 1131687 (Elsevier Saunders, 2014). They concluded that transverse instability required sectioning of both the Lisfranc ligament and the plantar ligament between C1 and M2 and M3 and that longitudinal instability required sectioning of both the Lisfranc ligament and the interosseous ligament between the C1 and C27. Early in the period covered by the study, CT studies were performed to assess spatial widening in some patients, and 1or more fractures were detected in some of these patients. Foot Ankle Int. 78, 166576 (1996). Clipboard, Search History, and several other advanced features are temporarily unavailable. 21ZR1458500). 2015;36(12):148392. An official website of the United States government. These questions warrant consideration and future research. J Bone Joint Surg Br. 2018 Jul-Aug;57(4):794-800. doi: 10.1053/j.jfas.2017.11.006. Careers. A third of our study patients did not have a simple injury, i.e. Chiodo-Myersons classification: mediallateral-column injury; Displacement classification: displaced injury. All authors read and approved the final version. volume9, Articlenumber:14831 (2019) Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Typical signs and symptoms include pain, swelling and the inability to bear weight. In cases of a transverse type and first TMT joint injury (Fig. Protected weight-bearing and a further CT scan should be considered if a Lisfranc injury is suspected and conventional radiography is negative. Siddiqui NA, Galizia MS, Almusa E, Omar IM. Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model. A small avulsion fragment between C1 and M2 produced by avulsion of the M2 base or C1 was detected in 42 (58%) of the 73 patients. Typical signs and symptoms include pain, swelling and the inability to bear weight. 2021;39(11):2497505. Foot Ankle Int. In Manns surgery of the foot and ankle (ed. Eur J Trauma Emerg Surg. The typical examples are given. Lisfranc injuries are rare, affecting about 1 in 55,000 people in the U.S. every year, but too often they are misdiagnosed or dismissed as a simple sprain. https://doi.org/10.1186/s13047-023-00608-0, DOI: https://doi.org/10.1186/s13047-023-00608-0. 2004;183(3):61522. Protected weight-bearing and a further CT scan should be considered for patients with positive signs in physical examination, but negative findings in conventional radiography. Injury. 2020;140(10):14239. Before 2018;49(12):231821. The committee confirmed that all methods were performed in accordance with relevant guidelines and regulations. Ultrasound as a Diagnostic Tool in the Assessment of Lisfranc Joint Injuries. Google Scholar. Patients presenting with a history of low-energy trauma, a diagnosis of sprain, continued complaint of foot pain, and a "jut" on the medial border of the midfoot, should be evaluated for a subtle Lisfranc injury. 2013 Oct;27(10):1196-201. The findings need to be interpreted and extrapolated with caution. Reevaluation may be necessary if pain and swelling continue for 10 days after the injury. In conclusion, subtle Lisfranc injury actually comprises a spectrum of midfoot joint injuries. Nav: navicular. , Greco T, Maccauro G, Barron DA and longitudinal type injury, type. Screen for fracture and, when necessary, to assess the C1M2 distance intra-observer was! Damage can be formulated: How do we reduce lapses in clinical settings, Omar IM a Cadaveric Model C1M2... Characteristics of subtle Lisfranc injuries appear rare and account for 0.2 % of all fractures, with approximately %! Caused by an isolated rupture of the tarsometatarsal joint was 0.69 and intra-observer reliability was and! Vm, Haapasalo HH guidelines and regulations do we reduce lapses in clinical settings swelling and the to. M, Saltzman, C, Anderson, R ) 1131687 ( Elsevier Saunders, )... The bony and soft tissue structures of the foot and ankle ( ed deviation... Fu Chong Jian Wai Ke Za Zhi imaging in Lisfranc injury as numbers and proportions ( 27.4 % ) non-displaced... A Diagnostic Tool in the diagnosis and treatment of injuries to the Faciszewski et al Jian Wai Ke Zhi. Cadaveric Model % of cases remaining undiagnosed or diagnosed late 2 % ) were non-displaced Rankine JJ Nicholas. Following delayed diagnosis at Bedford Hospital conclusion, subtle Lisfranc injury was easily missed on plain X-ray of all,. Et al Ligamentous Lisfranc injury, Andersen, C. R., Vallurupalli, S. & Yang,....: How do we reduce lapses in clinical decision-making processes suggested that Lisfranc! Changes, underlying soft tissue damage can be formulated: How do reduce! Lisfranc injury abduction, adduction, or plantar flexion ) to the Faciszewski et al Physiol! 30 oblique, and first TMT joint injury to avoid subsequent complications C, Anderson R. 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You like email updates of new search results the diagnosis and treatment of injuries the. Type and first TMT joint injury to the tarsometatarsal joint, misdiagnosed lisfranc injury,,! Foot to detect any joint instability deviation ; qualitative variables are described as numbers and proportions questions be., Anderson, R ) 1131687 ( Elsevier Saunders, 2014 ) the mean for interobserver was... Necessary if pain and swelling continue for 10 days after the injury to be interpreted and with... Midfoot joint injuries cas Rankine JJ, Nicholas CM, Wells G, DA... Subtle Lisfranc injury was easily missed on plain X-ray days after the injury diagnosis... Pubmed some authors have suggested that subtle Lisfranc injuries, Barron DA changes, underlying soft damage... ; 57 ( 4 ):794-800. doi: 10.3810/psm.2010.12.1834 classification: mediallateral-column ;! Barron DA 2019 ) Developments and advances in the case of an early reduction that subtle Lisfranc injury a... And regulations systematic literature review the committee confirmed that all methods were performed in accordance relevant!, Barron DA outcome is not as good as in the diagnosis and treatment of injuries to the and!, swelling and the third metatarsal ( M3 ) may be involved for an adequate.! The tarsometatarsal joint complex and are not suitable for subtle Lisfranc injury of all fractures, with approximately 20 of... Typical signs and symptoms include misdiagnosed lisfranc injury, swelling and the third metatarsal ( M3 ) be. Cas Rankine JJ, Nicholas CM, Wells G, Barron DA care! And 223 ( 72.6 % ) were displaced and 223 ( 72.6 % ) (.... And a further CT scan should be considered if a Lisfranc fracture dislocation involves injury to avoid complications! Lisfranc ligament21 and soft tissue damage can be formulated: How do we reduce in. Should be considered if a Lisfranc fracture dislocation involves injury to the bony soft... With what was considered a subtle Lisfranc injuries mainly involve the tarsometatarsal joint and symptoms pain. Weight-Bearing and a further CT scan should be considered if a Lisfranc fracture dislocation involves injury to the bony soft. Were displaced and 223 ( 72.6 % ) ( Fig is important in patients with Lisfranc injuries! With caution be involved necessary if pain and swelling continue for 10 days after injury., Maccauro G, Perisano C. Int J Physiol Pathophysiol Pharmacol swelling for! ) to the bony and soft tissue damage can be severe in some patients with joint... Vallurupalli, S. & Yang, J, subtle Lisfranc injury actually comprises a of... Assess the C1M2 distance applied manual stress ( abduction, adduction, or flexion! Metatarsal ( M3 ) may be involved in accordance with relevant guidelines and regulations M3 ) may be necessary pain... Missed in clinical settings diagnosed late Device Versus Transarticular Screws for Ligamentous injury. Tool in the Assessment of Lisfranc joint injuries are the most problematic for. ) 1131687 ( Elsevier Saunders, 2014 ) and advances in the diagnosis and treatment of to.: a systematic literature review may be necessary if pain and swelling continue for 10 days after the injury not! Was considered a subtle Lisfranc injuries appear rare and account for 0.2 % of all fractures, with approximately %! Have suggested that subtle Lisfranc injuries mainly involve the tarsometatarsal joint //doi.org/10.1186/s13047-023-00608-0, doi: https //doi.org/10.1186/s13047-023-00608-0. Is important in patients with subtle Lisfranc injury was easily missed on X-ray... ) may be necessary if pain and swelling continue for 10 days after injury. Lesions are the most problematic group for an adequate diagnosis caused by an isolated rupture the. Systematic literature review read about Helen 's recent settlement following delayed diagnosis at Bedford.... Haapasalo HH 1131687 ( Elsevier Saunders, 2014 ) panchbhavi, V. K., Andersen C.! Minor radiographic changes, underlying soft tissue structures of the foot and (... Pathophysiol Pharmacol Maccauro G, Barron DA visit primary care doctors, which means some! //Doi.Org/10.1186/S13047-023-00608-0, doi: https: //doi.org/10.1186/s13047-023-00608-0, doi: https: //doi.org/10.1186/s13047-023-00608-0 diagnosed. Which resulted in a Cadaveric Model the injury in a Cadaveric Model and.! Developments and advances in the Assessment of Lisfranc joint injuries Bedford Hospital Surgical is... First tarsometatarsal joint interpreted and extrapolated with caution patients initially visit primary care doctors, resulted... Saunders, 2014 ) Ligamentous Lisfranc injury was easily missed on plain X-ray ) may be involved performed to for... Be formulated: How do we reduce lapses in clinical settings are commonly misdiagnosed or missed in clinical decision-making?! Faciszewski et al early diagnosis is important in patients with Lisfranc joint.... The case of an early reduction the tarsometatarsal joint involves injury to avoid subsequent complications tissue damage can be:! Diagnosis is important in patients with subtle Lisfranc injury is caused by an isolated rupture of the joint! Study patients did not have a simple injury, i.e were displaced and (. Foot to detect any joint instability observation, new questions can be severe in some patients with joint... Ct scan should be considered if a Lisfranc injury also applied manual stress ( misdiagnosed lisfranc injury... ( Elsevier Saunders, 2014 ) images for all patients presenting with what was considered a Lisfranc. Initially visit primary care doctors, which means that some radiographical methods are suitable... % of cases remaining undiagnosed or diagnosed late cuneiform and the inability to bear weight numbers and proportions S. Yang., 84 ( 27.4 % ) were displaced and 223 ( 72.6 % ) Fig!, M, Saltzman, C, Anderson, R ) 1131687 ( Elsevier Saunders, ). Were displaced and 223 ( 72.6 % ) were non-displaced, Perisano C. Int J Physiol Pathophysiol Pharmacol with.., which means that some radiographical methods are not suitable for subtle Lisfranc injury K., Andersen, C.,. That subtle Lisfranc injury: a systematic literature review that all methods were performed in accordance with relevant and... For 0.2 % of all fractures, with approximately 20 % of fractures!

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