E4673. Lisfranc and Chopart Injuries: Anatomy, Injury Mechanisms, and Management
  1. Afshin Ameri; Tufts Medical Center
  2. Rita Lahoud; Tufts Medical Center
  3. Megan Kenway; Tufts Medical Center
  4. Rosaura Suazo Aguero; Tufts Medical Center
  5. Hasan Khan; Tufts Medical Center
  6. Brian Fu; Tufts University
  7. Daichi Hayashi; Tufts Medical Center
Lisfranc and Chopart injuries are complex and potentially debilitating foot injuries that involve disruption to the tarsometatarsal and midtarsal articulations, respectively. These injuries often result from high-energy trauma, sports-related accidents, and motor vehicle collisions. Prompt diagnosis is essential to prevent long-term functional impairment and optimize patient outcomes. Radiologists play a critical role as the primary diagnosticians with conventional radiography as the initial modality on presentation. Cross-sectional imaging plays a pivotal role in further delineation of these injuries. This exhibit provides an overview of the key radiological features associated with Lisfranc and Chopart injuries, emphasizing their importance in guiding treatment decisions and postinjury management.

Educational Goals / Teaching Points
First, we describe the significance of comprehending the intricate anatomy and biomechanics governing the Lisfranc and Chopart joint complexes. Second, we explain the importance of the radiologist familiarizing themselves with the injury mechanisms and the classification systems utilized in characterizing these specific injuries. Third, our exhibit discusses the indications and options for surgical management, providing insights into the decision-making process. Moreover, we describe the preoperative planning and the pivotal role of imaging modalities in guiding the choice for accurate therapeutic interventions. Last, we discuss the potential postoperative complications associated with Lisfranc and Chopart injuries, illuminating their appropriate management strategies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The Chopart joint comprises the calcaneocuboid and talonavicular articulations, aligned perpendicularly to the foot’s arch. Key ligaments include the bifurcate ligament, and the calcaneocuboid ligaments. The Lisfranc joint complex involves the medial, middle, and lateral cuneiforms, the cuboid, and metatarsal bases. The Lisfranc ligament connects the medial cuneiform to the second metatarsal base consisting of dorsal, plantar, and interosseous ligaments, with the latter being the strongest in the complex. In the Lisfranc joint, the tibialis anterior tendon's insertion onto the dorsum of the first metatarsal base and medial cuneiform provides dynamic stability to the first tarsometatarsal articulation. Similarly, the peroneus longus tendon's attachment onto the plantar-lateral surface of the first metatarsal provides lateral support to the calcaneocuboid joint.

Comprehensive understanding of these injuries is crucial for accurate diagnosis and effective management. By recognizing the diverse mechanisms of injury and employing appropriate classification systems, radiologist can aid surgeons and clinicians to tailor treatment strategies to optimize patient outcomes. A multidisciplinary approach, incorporating radiological expertise and clinical insight, is pivotal in ensuring the optimal care of patients with Lisfranc and Chopart injuries.