Lisfranc fracture dislocation

Plain radiographs:
AP view:
Alignment of lateral border of 1st metatarsal base with lateral border of medial cuneiform
Alignment of medial border of 2nd metatarsal base with medial border of middle cuneiform
First intermetatarsal gap should be less than 2 mm
Fleck sign in 1st intermetatarsal gap (flake fracture)

Oblique view:
Alignment of medial and lateral borders of 3rd metatarsal with lateral cuneiform
Alignment of medial border of 4th metatarsal with medial border of cuboid

Lateral view:
Step-off sign: dorsal displacement of 2nd metatarsal base compared to tarsal bones

References:
Injury Extra, Volume 38 (2007), 250-254

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