Ligamentous instability of the first ray: A case report introducing the naviculocuneiform kissing sign on MRI scan

Acute instability of the first ray following trauma is a rare type of Lisfranc injury. Plain radiographs may demonstrate instability if there is a clear dislocation of the first ray, however subtle injuries are difficult to recognise. Magnetic resonance imaging (MRI) has been described in the litera...

Full description

Saved in:
Bibliographic Details
Published inFoot & ankle surgery (New York, N.Y.) Vol. 2; no. 2; p. 100170
Main Authors Vather, Mehr, Nguyen, Antony, Ghasemzadeh, Milad, Molnar, Robert, Symes, Michael
Format Journal Article
LanguageEnglish
Published Elsevier Inc 2022
Elsevier
Subjects
Online AccessGet full text

Cover

Loading…
More Information
Summary:Acute instability of the first ray following trauma is a rare type of Lisfranc injury. Plain radiographs may demonstrate instability if there is a clear dislocation of the first ray, however subtle injuries are difficult to recognise. Magnetic resonance imaging (MRI) has been described in the literature as an adjunct in the diagnosis of subtle Lisfranc injuries. There has been no description of the use of MRI and the unique findings of instability of the first ray in the acute setting. We report 2 cases of traumatic instability of the first ray of the foot. Both cases underwent plain radiographs, where in one patient there was a suggestive Lisfranc injury and the other patient had normal radiographical findings. Further investigation utilising an MRI showed a distinct pattern of bone bruising in the navicular and medial cuneiform at the naviculocuneiform joint. These findings indicated disruption of the ligamentous construct stabilising the first ray to the foot. Operative management was undertaken and both patients had a good outcome. This case report is important as it is the first to describe the unique MRI findings of instability of the first ray which will enable other clinicians to appropriately diagnose and manage this injury.
ISSN:2667-3967
2667-3967
DOI:10.1016/j.fastrc.2022.100170