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...
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Published in | Foot & ankle surgery (New York, N.Y.) Vol. 2; no. 2; p. 100170 |
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Format | Journal Article |
Language | English |
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Elsevier Inc
2022
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Abstract | 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. |
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AbstractList | 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. |
ArticleNumber | 100170 |
Author | Vather, Mehr Ghasemzadeh, Milad Symes, Michael Nguyen, Antony Molnar, Robert |
Author_xml | – sequence: 1 givenname: Mehr surname: Vather fullname: Vather, Mehr organization: Hospital Affiliation, Campbelltown Hospital, Australia – sequence: 2 givenname: Antony surname: Nguyen fullname: Nguyen, Antony email: antony_nguyen@hotmail.com organization: Hospital Affiliation, St George Hospital, Australia – sequence: 3 givenname: Milad orcidid: 0000-0003-1613-5439 surname: Ghasemzadeh fullname: Ghasemzadeh, Milad organization: Hospital Affiliation, Gosford Hospital, Australia – sequence: 4 givenname: Robert surname: Molnar fullname: Molnar, Robert organization: Hospital Affiliation, St George Hospital, Australia – sequence: 5 givenname: Michael orcidid: 0000-0002-4613-2653 surname: Symes fullname: Symes, Michael organization: Hospital Affiliation, St George Hospital, Australia |
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Cites_doi | 10.1007/s00256-019-03282-1 10.1038/s41598-019-51358-8 10.1136/emermed-2015-205317 10.1053/j.jfas.2012.06.021 10.1177/107110079801900213 10.2106/JBJS.H.01075 10.1136/bjsm.2003.006718 10.1302/2058-5241.4.180076 10.1302/0301-620X.75B1.8421016 10.2214/AJR.10.4674 10.1016/S1083-7515(03)00003-2 |
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Keywords | Lisfranc Diagnosis Foot and ankle surgery Midfoot fracture MRI New sign |
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SubjectTerms | Diagnosis Foot and ankle surgery Lisfranc Midfoot fracture MRI New sign |
Title | Ligamentous instability of the first ray: A case report introducing the naviculocuneiform kissing sign on MRI scan |
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