The classification in most common use is that of Quenu and Kuss (1909) as modified by Hardcastle (1979). Myerson (1986) relabelled the classification:
- Total incongruity (type A) - can be either medially or laterally displaced
- Partial incongruity, either medial (type B1) or lateral (type B2) – the commonest group
- Divergent displacement, either partial (type C1) or total (type C2)
Talarico (2006) assessed the degree of agreement among 21 foot and ankle surgeons of varying degrees of seniority in assessing 13 radiographs of Lisfrcn injuries. The images were chosen to represent the full classification as described by Myerson. Kappa statistics were used to measure agreement; overall kappa was 0.54 indicating moderate agreement. Talarico did not report whether more experienced surgeons had greater levels of agreement.
Type A (medial)
Type A (lateral)
Type B2 (partial)
Type B2 (complete)
Type B2 partial
Subtle Lisfranc injuries
Faciszewski et al (1990) drew attention to a group of injuries (“subtle Lisfranc injuries”) in which malalignment or divergence of the first and second rays was only apparent on weightbearing. 11% of Vuori’s (1993) series had a subtle Lisfranc injury.
In the NWB film there is a possible increase in space between the 1st and 2nd rays but the 2nd MT is parallel with the middle cuneiform. In the WB film the 2nd MT is no longer parallel with the middle cuneiform. Slight rotation between the two images limits the appreciation of the increase in space between the 1st and 2nd rays.