Patients with mid/hindfoot fractures and injury to the Lisfranc ligament had increased regional bone density in a new study.
Another Reason for Bone Density Tests: Lisfranc Injuries
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The researchers said that their findings “expanded the utility of regional bone density analysis in foot and ankle trauma.”
The study, “Correlation of Lisfranc Injuries with Regional Bone Density,” was published online on June 27, 2022, in the Journal of Foot & Ankle Surgery.
The Lisfranc joint is where the metatarsal bones and the tarsal bones meet. Injuries to this joint most commonly occurs to car accident victims, military personnel, runners, horseback riders, and athletes who play contact sports.
“Lisfranc injuries present a challenge due to their ubiquity though frequent missed diagnoses. A paucity of data exists associating the contribution of bone density to injury type,” the researchers wrote.
Researchers conducted a retrospective review of computed-tomography data of 134 patients identified with gross ligamentous and avulsion-type Lisfranc injuries. They assessed regional bone density by averaging the Hounsfield units of the first metatarsal base, navicular, cuboid, calcaneus and talus. They also compared the density between injury type, isolated concomitant forefoot, and mid/hindfoot fractures. Overall, there were 85 patients with avulsion and 49 with ligamentous Lisfranc injuries.
Overall, the regional bone density of the cuboid (p = 0.03) and talus (p = 0.04) was greater in the ligamentous group. And lower extremity concomitant mid/hindfoot fracture patients exhibited greater regional bone density in the ligamentous group in all assessed bones (p ≤0.04) except the calcaneus.
Study authors included Dominick J. Casciatio, D.P.M., Amar Chandra, D.P.M., Kevin Nguyen, D.P.M., Robert W. Mendicino, D.P.M., F.A.C.F.A.S., and Benjamin C. Taylor, M.D., all of OhioHealth Grant Medical Center, Columbus, Ohio. John Thompson, D.P.M., A.A.C.F.A.S, a fellow at Orthopedic Foot & Ankle Center in Worthington, Ohio and Nathaniel Starcher, MS-11, a student at Ohio University Heritage College of Osteopathic Medicine also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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