title: The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection.
abstract: OBJECTIVE
  The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. In addition, a foot phantom was investigated to determine the optimum degree of craniocaudal angulation on the anteroposterior radiograph to best show the joint. The angle of the joint in patients with midfoot injury was investigated to determine the optimum degree of craniocaudal angulation.
  
  
  METHODS
  Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. This was compared with the angle of the joint as measured on CT. The angle of the joint in all 60 patients was measured on CT.
  
  
  RESULTS
  The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. Twenty degrees of craniocaudal angulation best showed the second tarsal-metatarsal joint of the phantom, and this correlated with a 20° angle measured by CT. The mean (± SD) angle of the joint in the patients was 28.9° ± 5.7°.
  
  
  CONCLUSIONS
  Conventional radiographs miss a significant number of cases of Lisfranc injury. Craniocaudal angulation can better show the joint, and an angle of 28.9° is likely to optimally visualize the joint in the majority of patients.
authors.affiliation: Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK. james.rankine@leedsth.nhs.uk
authors.forename: James J
authors.initials: JJ
authors.lastname: Rankine
authors.forename: Chris M
authors.initials: CM
authors.lastname: Nicholas
authors.forename: Gareth
authors.initials: G
authors.lastname: Wells
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Barron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013640:Tarsal Joints / Q000000981:diagnostic imaging* / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods*