Abstract：
BACKGROUND: Lisfranc injuries refer to a disruption or displacement of the tarsometatarsal joint of the foot. Subtle Lisfranc injuries can go undiagnosed on conventional imaging leading to devastating consequences and poor functional outcomes for elite athletes. Objective. The objective of this case study is to present a novel imaging technique using weight-bearing computed tomography (CT) with enhanced stress to identify subtle, dynamically unstable Lisfranc injuries. We illustrate this with a case presentation of an elite athlete who ultimately required surgical fixation for a subtle Lisfranc injury.
METHODS: To perform an augmented stress weight-bearing CT, the patient was positioned standing, with their feet facing forward, and weight equally distributed. The patient was then coached to symmetrically raise both heels from the scanner platform. This plantarflexion provided augmented stress on the midfoot, allowing for more sensitive imaging of the Lisfranc injury. The weight-bearing CT and augmented stress images undergo 3D reconstruction and postprocessing to render coronal and sagittal images, allowing for comparison of the standard weight-bearing and augmented stress images.
RESULTS: We present the case of a 22-year-old collegiate football lineman sustaining a Lisfranc injury. The injury diagnosis was made by magnetic resonance imaging (MRI) and clinical examination, without evidence of injury on weight-bearing XR or standard weight-bearing CT. With augmented stress CT imaging, the Lisfranc instability was noted, leading to surgical fixation, and return to sport the next season.
CONCLUSIONS: We propose this technique for diagnosing subtle, unstable Lisfranc injuries where clinical suspicion persists despite inconclusive imaging, particularly in elite athletes. Further research is needed with larger sample sizes to investigate the sensitivity of this novel imaging technique for the detection of Lisfranc injury.
UNASSIGNED: Level 4: Case Report.
METHODS: To perform an augmented stress weight-bearing CT, the patient was positioned standing, with their feet facing forward, and weight equally distributed. The patient was then coached to symmetrically raise both heels from the scanner platform. This plantarflexion provided augmented stress on the midfoot, allowing for more sensitive imaging of the Lisfranc injury. The weight-bearing CT and augmented stress images undergo 3D reconstruction and postprocessing to render coronal and sagittal images, allowing for comparison of the standard weight-bearing and augmented stress images.
RESULTS: We present the case of a 22-year-old collegiate football lineman sustaining a Lisfranc injury. The injury diagnosis was made by magnetic resonance imaging (MRI) and clinical examination, without evidence of injury on weight-bearing XR or standard weight-bearing CT. With augmented stress CT imaging, the Lisfranc instability was noted, leading to surgical fixation, and return to sport the next season.
CONCLUSIONS: We propose this technique for diagnosing subtle, unstable Lisfranc injuries where clinical suspicion persists despite inconclusive imaging, particularly in elite athletes. Further research is needed with larger sample sizes to investigate the sensitivity of this novel imaging technique for the detection of Lisfranc injury.
UNASSIGNED: Level 4: Case Report.
摘要：
背景：Lisfranc损伤是指脚掌掌关节的破坏或移位。微妙的Lisfranc受伤可能无法通过常规成像进行诊断，从而导致精英运动员的破坏性后果和不良的功能结果。Objective.本案例研究的目的是提出一种新颖的成像技术，使用负重计算机断层扫描（CT）增强应力来识别细微的，动态不稳定的Lisfranc受伤。我们以一名精英运动员的案例说明了这一点，他最终需要手术固定以治疗微妙的Lisfranc受伤。
方法：要进行增强应力负重CT，病人站着，双脚朝前,和重量均匀分布。然后指导患者从扫描仪平台对称地抬起两个脚跟。足底弯曲增加了中足的压力，允许对Lisfranc损伤进行更灵敏的成像。负重CT和增强应力图像经过三维重建和后处理，以渲染冠状和矢状图像，允许比较标准的负重和增强的应力图像。
结果：我们介绍了一名22岁的大学足球边锋Lisfranc受伤的情况。通过磁共振成像（MRI）和临床检查做出损伤诊断。无负重XR或标准负重CT损伤的证据。增强应力CT成像，注意到Lisfranc不稳定，导致手术固定，并在下个赛季回归运动。
结论：我们提出这种技术用于诊断细微的，不稳定的Lisfranc损伤，尽管影像学不确定，但临床怀疑仍然存在，尤其是精英运动员。需要对更大的样本量进行进一步的研究，以研究这种新型成像技术检测Lisfranc损伤的敏感性。
■第4级：病例报告。
方法：要进行增强应力负重CT，病人站着，双脚朝前,和重量均匀分布。然后指导患者从扫描仪平台对称地抬起两个脚跟。足底弯曲增加了中足的压力，允许对Lisfranc损伤进行更灵敏的成像。负重CT和增强应力图像经过三维重建和后处理，以渲染冠状和矢状图像，允许比较标准的负重和增强的应力图像。
结果：我们介绍了一名22岁的大学足球边锋Lisfranc受伤的情况。通过磁共振成像（MRI）和临床检查做出损伤诊断。无负重XR或标准负重CT损伤的证据。增强应力CT成像，注意到Lisfranc不稳定，导致手术固定，并在下个赛季回归运动。
结论：我们提出这种技术用于诊断细微的，不稳定的Lisfranc损伤，尽管影像学不确定，但临床怀疑仍然存在，尤其是精英运动员。需要对更大的样本量进行进一步的研究，以研究这种新型成像技术检测Lisfranc损伤的敏感性。
■第4级：病例报告。
