Bone scintigraphy in the diagnosis of Lisfranc fracture

Abstract

Background: Lisfranc injuries are uncommon and difficult to diagnose. These injuries have a high potential for causing substantial disability related to post-traumatic osteoarthritis and should be managed early to avoid such complications. Lisfranc injuries are frequently missed on radiographs. Hence, bone scanning may be a useful modality in the diagnosis of Lisfranc fracture. Objectives: To investigate the utility of bone scintigraphy in the diagnosis of undiagnosed cases of Lisfranc fracture. Materials and Methods: We studied 13 cases of Lisfranc fracture (8 females and 5males), that were not diagnosed on plain X-ray. Three-phase bone scintigraphy was performed for each patient after administration of 20 mCi (740 MBq) of Tc-99m MDP using a dual-head gamma camera, interfaced with computer. Flow, blood pool and delayed imaging of the feet were performed for each patient, as well as whole body blood pool and delayed images. Results: All the bone scintigraphic studies of the patients showed hyperemia of the affected foot in flow and blood pool studies and focal area of increased uptake at the mid foot region, particularly the tarsometatarsal joint, in the delayed images typical of Lisfranc fracture. However, X-ray of affected foot previously obtained were available in 11 patients and were normal in 10 patients, while suspicious reflex sympathetic dystrophy was seen in one. Conclusion: Hence, it is essential to be highly aware of the entity of Lisfranc fracture-dislocation when evaluating patients who have mid foot pain, swelling, and its scintigraphic pattern. Because bone scintigraphy is, a useful modality in diagnosing Lisfranc fracture we recommend that it should be more utilized when X-ray is not diagnostic.