Correlative Imaging of the Tarsometatarsal Joint

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 25, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.25
Procedures: 2.25
Head, Spine, and Musculoskeletal: 2.25

Magnetic Resonance Imaging: 3.50
Procedures: 3.50
Musculoskeletal: 3.50

Nuclear Medicine Technology: 2.25
Procedures: 2.25
Other Imaging Procedures: 2.25

Radiography: 3.50
Procedures: 3.50
Extremity Procedures: 3.50

Registered Radiologist Assistant: 3.50
Procedures: 3.50
Musculoskeletal and Endocrine Sections: 3.50

Sonography: 2.25
Procedures: 2.25
Superficial Structures and Other Sonographic Procedures: 2.25

Outline

1. Introduction
2. Anatomy
3. Mechanisms of Injury
4. Classification Systems
   1. Lisfranc Fracture-Displacements
      1. Quen¸ and K¸ss
      2. Myerson
   2. Lisfranc Sprains: Nunley and Vertullo Classification
5. Imaging Characteristics
   1. Conventional Radiography
   2. Bone Scintigraphy
   3. Ultrasonography
   4. Computed Tomography
   5. MR Imaging
6. Treatment
7. Conclusion

Objectives

Upon completion of this course, students will:

1. describe the clinical symptoms a patient may exhibit with a Lisfranc joint complex injury
2. understand the role that medical imaging modalities play in assisting in the diagnosis of a Lisfranc joint complex injury
3. know who the tarsometatarsal joint is named after
4. describe the difference between low impact and high impact Lisfranc joint complex injuries and the most common cause of each
5. know what percentage of Lisfranc joint complex injuries initially go undiagnosed
6. understand which bones of the foot make up the Roman arch configuration of the Lisfranc joint
7. name the articulations that make up the Lisfranc joint complex
8. know the names of the ligaments that provide stability to the Lisfranc joint complex
9. know which of the ligaments in the Lisfranc joint complex are the strongest and which are the weakest
10. name the most prominent nerves and vascular component that make up the Lisfranc joint complex
11. name both direct and indirect mechanisms of injury to the Lisfranc joint complex
12. be familiar with what types of Lisfranc joint injuries affect athletes
13. name the first classification system for Lisfranc joint complex fractures
14. describe the Quenü and Küss classification of high-grade Lisfranc fracture-displacements
15. know which of the Quenü and Küss Classification of High-Grade Lisfranc Fracture-Displacements is the most common
16. describe the modifications that Hardcastle made to the Quenü and Küss classification of high-grade Lisfranc fracture-displacements
17. describe the modifications that Myerson made to the Hardcastle classification of high-grade Lisfranc fracture-displacements
18. know which classification system of high-grade Lisfranc fracture-displacements is the most commonly used today
19. describe the Nunley-Vertullo classification of low-grade midfoot sprains
20. understand the role conventional radiography plays in diagnosing Lisfranc joint complex injuries
21. describe the technical nuances of performing proper foot radiography
22. describe the radiographic anatomy of the foot that is best visualized on each projection
23. know what percentage of subtle Lisfranc joint complex injuries will appear normal on non-weight-bearing radiographic studies
24. describe the radiographic fleck sign
25. explain the necessary ancillary equipment needed to safely perform weight-bearing foot radiography to better diagnose Lisfranc joint complex injuries
26. know the most frequent and reliable indicator of a Lisfranc joint complex injury on radiographic studies
27. define the role that bone scintigraphy plays in the diagnosis of Lisfranc joint complex injuries, as well as its benefits and limitations
28. know what role diagnostic ultrasound plays in the evaluation of patients with Lisfranc joint complex injuries
29. know which projections are used with diagnostic ultrasound of the Lisfranc joint complex
30. describe the benefits and limitations of using CT as a medical imaging modality in the diagnosis of Lisfranc joint complex injuries
31. know the role that 3D reformatted CT plays in patients presenting with Lisfranc joint complex injuries
32. describe the role MR imaging plays in the diagnosis of a Lisfranc joint complex injury
33. know what size field of view is used in MR imaging of the Lisfranc joint complex
34. describe the types of sequences used in MR imaging of the foot for Lisfranc joint complex injuries
35. know which anatomic plane the intermetatarsal ligaments are best visualized with MR imaging
36. know which anatomical plane that the Lisfranc ligament is best visualized with MR imaging
37. describe the most common findings on MR imaging that indicative of ligament damage to the foot
38. know what non-operative treatment options are available for Lisfranc joint complex injuries
39. describe what criteria the treatment of Lisfranc joint complex injuries are based upon
40. know what type of Lisfranc joint complex injuries are treated surgically as well as the various procedures performed