Classification in 157 patients with Lisfranc injuries using three-dimensional fracture lines and heat map.

Background: Recently Lisfranc fractures have increased due to increased high-energy injuries from various causes. However, due to incomplete traditional classification, the pattern and distribution of fractures cannot be analyzed in three dimensions. This study examines a novel fracture pattern based on the fracture line and heat map for Lisfranc injuries.

Methods: We retrospectively analyzed data from CT scans of 157 patients diagnosed with Lisfranc injuries. We extracted the CT data of a healthy adult and created a standard foot model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization.

Results: The novel classification identifies high-density fracture sites within the tarsometatarsal joint, predominantly localized in the medial and lateral columns. The fracture lines not involving the TMT joint are mainly located in the medial aspect of the first metatarsal trunk and the fifth metatarsal trunk. Additionally, we develop an assessment protocol for Lisfranc injury that incorporates ligament injury, displacement, and fracture.

Conclusion: The new classification accurately identifies the different types of fractures in Lisfranc injuries, enabling clinicians to more fully and accurately understand their patients' injuries and assisting them in efficiently making sound decisions to avoid diagnostic delays that can negatively impact postoperative outcomes.