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Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury

Authors
 Dong Woo Shim  ;  Eunyoung Choi  ;  Young-Chang Park  ;  Sung Chul Shin  ;  Jin Woo Lee  ;  Seung-Yong Sung 
Citation
 ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, Vol.142(12) : 3705-3714, 2022-12 
Journal Title
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN
 0936-8051 
Issue Date
2022-12
MeSH
Case-Control Studies ; Decision Making ; Humans ; Metatarsal Bones* / diagnostic imaging ; Metatarsal Bones* / surgery ; Reproducibility of Results ; Retrospective Studies ; Tomography, X-Ray Computed / methods
Keywords
Computed tomography ; Diagnosis ; Radiographs ; Subtle Lisfranc injury
Abstract
Introduction: Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI.

Methods: We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed.

Results: Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P ≤ 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane.

Conclusion: Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance.

Level of evidence: Case control study; III.
Full Text
https://link.springer.com/article/10.1007/s00402-021-04182-7
DOI
10.1007/s00402-021-04182-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Young Chang(박영창) ORCID logo https://orcid.org/0000-0003-3726-4707
Lee, Jin Woo(이진우) ORCID logo https://orcid.org/0000-0002-0293-9017
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/193228
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