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The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario: How are we Doing?

Mayich DJ, Charnish M, Holden R, Grant H and Harrison MM

Objectives: Subtle Injuries to the Lisfranc's joint complex (or LFIs) can be difficult to diagnose on initial presentation to the primary care physician (or PCP). Significant research has gone into subspecialty imaging and operative management of LFIs. Little research, unfortunately, has gone into how PCPs, who are typically must initially suspect, and ultimately diagnose LFIs initially, perform when seeing cases typical of LFIs.

Methods: A survey that assessed the diagnostic accuracy and management of LFIs in PCPs in Ontario was designed and validated. A final survey was circulated, via mail, to PCPs in southeastern Ontario. 189 of the 851 (22.2%) contacted PCPs responded to the survey. Demographic data was collected and compared to available information to ensure a representative sample.

Results: With reference to subtle LFIs, A misdiagnosis of "soft tissue sprain" was made 35% of the time, while only 17% of respondents were able to correctly identify the unstable nature of the injury. 54% of responding PCPs indicated follow-up with an orthopaedic surgeon within the recommended two weeks.

Conclusions: A directed educational intervention aimed at teaching PCPs in Ontario the principles for diagnosis and management of LFIs is indicated. These interventions may potentially help in increasing understanding and increasing the level of clinical suspicion when presented with the clinical scenario that can be associated with LFIs.