ABSTRACT
Objective:To investigate the manifestations of different imaging methods of Lisfranc joint injury and their classification, providing a theoretical basis for increasing the rate of diagnosis of Lisfranc joint injury.Methods:The clinical data of 238 patients with Lisfranc joint injury who received treatment in the First People's Hospital of Wenling from January 2017 to January 2020 were retrospectively analyzed. According to the different types of injury, the clinical data were classified into Myerson and Nunley-Vertullo types and then statistically analyzed. The features of X-ray, CT and MRI images of injured Lisfranc joint were observed.Results:Among the 238 patients, 175 had Lisfranc joint fracture and dislocation, with Myerson classification type I 18 patients, type II 149 patients, and type III 8 patients; 63 had Lisfranc joint injury or sprain, with Nunley-Vertullo classification type I 14 patients, type II 45 patients and type III 4 patients. Only X-ray examination was performed in 8 patients, only CT scan in 10 patients, and only MRI in 17 patients. Both X-ray examination and CT scan were performed in 172 patients, both X-ray examination and MRI in 13 patients, both CT scan and MRI in 13 patients, and all X-ray examination, CT scan and MRI in 5 patients. The correct rate of the first X-ray diagnosis was 85.35% (169/198). In 157 patients with Myerson-type Lisfranc joint injury, the correct rate of diagnosis was 92.36% (145/157). In 41 patients with Nunley-Vertullo-type Lisfranc joint injury, the correct rate of diagnosis was 65.85% (27/41). There was significant difference in the correct rate of diagnosis between Myerson-type and Nunley-Vertullo-type Lisfranc joint injury ( χ2 = 5.135, P = 0.024). CT scan examination invovled the basal part of M2 in 88.50% (177/200) of patients, the basal part of M2-M4 in 64.00% (128/200) of patients, and the lateral dislocation of M2 in 65.00% (130/200) of patients . Three-dimensional reconstructions revealed that 37.00% (74/200) of patients had dorsal dislocation or subluxation and 7.50% (14/200) of patients had metatarsal dislocation or subluxation. MRI examination revealed that six patients had grade I injury, showing abnormal but uninterrupted signal, 24 patients had grade II injury, showing partial rupture of ligament, and 18 patients had grade III injury, showing complete rupture of ligament (interrupted or absent ligament signal). Conclusion:Among the different imaging diagnostic methods of Lisfranc joint injury, X-ray examination may lead to missed diagnosis. For patients with highly suspected Lisfranc joint injury who are not confirmed to suffer from Lisfranc joint injury by X-ray examination, CT scan or MRI should be performed.