WEIGHT BEARING X-RAYS FOR LISFRANC JOINT INJURY INSTABILITY & FRACTURE

WEIGHT BEARING X-RAYS FOR LISFRANC JOINT INJURY INSTABILITY & FRACTURE
In this video, we're going to look at joint injuries and instability and why weight-bearing views are very important when we are trying to assess for instability at the Lisfranc joint.
This is a recent case and we have a fracture through the base of the fourth metatarsal. The Lisfranc joint here actually looks fine. There's no widening. The space between the first cuneiform and the base of the second metatarsal is not widened and we can't see a flake fra gment.
Now, this is the same patient with weightbearing views. And now we have widening of that space. Between C1 and the base of the second metatarsal. There's widening of that space. And additionally, what we see is a small fragment here. So this is the small flake fragment, which we couldn't see on the non-weightbearing views. And so now we have evidence of instability at this Lisfranc joint.
So the important thing when assessing an x-ray is that, if you can do weight-bearing view for midfoot trauma, because you're more likely to see instability on a weight-bearing view than you would on a non-weightbearing view.
Although, it may not be possible to do weight-bearing view because often the patients are in quite significant pain and they won't be able to weight bear. so if it is possible, then try and do a weight-bearing view.
Additionally, comparison views of the contralateral foot are also very useful. So do weightbearing and non-weightbearing views of both feet. And look for subtle instability. So you're looking for subtle widening on the affected side. And often this is easy to recognize that subtle widening when you do a direct comparison, with a normal foot. So. If you're doing weight bearing, do a contralateral image as well.
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