Bone Scintigraphy in the Diagnosis of Lisfranc Fracture

AIM: Lisfranc injuries are uncommon and difficult to diagnose.\ud These injuries have a high potential for causing substantial disability\ud related to post-traumatic osteoarthritis and should be managed early\ud to avoid such complications. Lisfranc injuries are frequently missed\ud on radiographs. Hence, bone scanning may be a useful modality in\ud the diagnosis of Lisfranc fracture. To investigate the utility of bone\ud scintigraphy in the diagnosis of radiographically undiagnosed cases\ud of Lisfranc fracture.\ud Methods: We studied Thirteen (13) cases of Lisfranc fracture (8\ud females and 5males), were included in this study. Each patient was\ud intravenously administered 20 mCi (740 MBq) of Tc-99m MDP\ud and three-phase bone scintigraphy was performed using a dual-head\ud gamma camera, interfaced with computer. Whole body blood pool\ud and delayed images were obtained as well as flow, blood pool and\ud delayed images of the feet.\ud Results: All the bone scintigraphic studies of the patients showed\ud hyperemia of the affected foot in flow and blood pool studies and\ud focal area of increased uptake at the mid foot region, particularly\ud the tarsometatarsal joint in the delayed images typical of Lisfranc\ud fracture. However, X-ray of affected foot previously obtained\ud were available in 11 patients and were normal in 10 patients, while suspicious reflex sympathetic dystrophy was reported in one.\ud Conclusion: This study showed the the importance of bone\ud scintigraphy in the detection of radiologically occult lisfranc injuries.\ud It also showed essence of being highly aware of the entity of Lisfranc\ud fracture-dislocation when evaluating patients who have mid foot\ud pain, swelling, and its scintigraphic pattern. We recommend that bone\ud scintigraphy should be utilized more when X-ray is not diagnostic of\ud Lisfranc fracture