Conventional radiography, CT, and MR imaging in patients with hyperflexioninjuries of the foot: Diagnostic accuracy in the detection of bony and ligamentous changes

OBJECTIVE. The goal of this study was to compare the capabilities of conven tional radiography, CT, and MR imaging in revealing ligamentous and bony ch anges in patients after hyperflexion injuries. SUBJECTS AND METHODS. Forty-nine patients with hyperflexion injuries of the foot were included in our study. Conventional radiography, weight-bearing radiography, CT, and MR imaging were performed. All images were reviewed wi th respect to ligamentous and bony abnormalities and alignment alterations. Eleven patients with joint malalignment underwent surgery, which is consid ered the gold standard in these patients. Five patients with joint malalign ment refused surgery. RESULTS. For all 49 patients, conventional radiographs revealed 33 metatars al and 20 tarsal fractures. Eight patients presented with tarsometatarsal j oint (Lisfranc's joint) malalignment. Weight-bearing radiographs showed joi nt malalignment in the same eight patients only. CT showed 41 tarsal fractu res and 53 metatarsal fractures. Joint malalignment was evident in 16 patie nts. MR imaging revealed 41 metatarsal fractures and 18 metatarsal bone bru ises. Tarsal bones were fractured at 39 sites and there were nine tarsal bo ne bruises. Metatarsal fractures were mostly localized in the second metata rsal bone; tarsal fractures, in the cuboid. Joint malalignment was evident in 16 patients; in 11 of these 16 patients, Lisfranc's ligament was disrupt ed. Surgery confirmed bony and ligamentous changes and joint malalignment i n 11 patients. CONCLUSION. Conventional radiographs including weight-bearing images are no t sufficient for routine diagnostic workup of patients with acute hyperflex ion injuries of the foot. CT should serve as the primary imaging technique for such patients.