Abstract
Lisfranc injuries present a challenge due to their ubiquity though frequent missed
diagnoses. A paucity of data exists associating the contribution of bone density to
injury type. This investigation compares the regional bone density between Lisfranc
injury types using computed-tomography (CT)-derived Hounsfield units. A retrospective
chart review identified patients with gross ligamentous and avulsion-type Lisfranc
injuries determined by CT examination of the second metatarsal base and medial cuneiform.
Regional bone density was assessed by averaging the Hounsfield units of the first
metatarsal base, navicular, cuboid, calcaneus, and talus between 2 reviewers. Density
was compared between injury type, isolated concomitant forefoot, and mid/hindfoot
fractures. One hundred thirty-four patients were separated into avulsion (n = 85)
and ligamentous (n = 49) groups. No statistically significant difference in patient
body mass index, age, smoking status, or Quenu and Kuss injury pattern was observed
between groups. The regional bone density of the cuboid (p = .03) and talus (p = .04) was greater in the ligamentous group. Lower extremity concomitant mid/hindfoot
fracture patients exhibited greater regional bone density in the ligamentous group
in all assessed bones (p ≤ .04) except the calcaneus. Ligamentous injuries of the Lisfranc complex are associated
with increased regional bone density among patients sustaining concomitant mid/hindfoot
fractures. This study expands the utility of regional bone density analysis in foot
and ankle trauma.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: June 27, 2022
Footnotes
Financial Disclosure: The authors have not received grant support or research funding.
Conflict of Interest: The authors do not have any proprietary interests in the materials described in the article. Dr. Taylor receives royalties from and is a consultant for Zimmer Biomet; royalties from Innomed; consultant for Atricure; and is on the editorial board of orthobullets.com. None of these affiliations pose a conflict of interest or were aware/responsible for any funding in the course of this study.
IRB approval was granted through IRB # 1728385-2.
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