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Lisfranc Fracture 1. Always obtain 3 views of the foot: AP, lateral, and 30 degrees oblique 2. Weight bearing views can show subtle widening of articulation spaces and point out instability due to lisfranc ligamentous injuries 3. On the AP view, any diastasis of more than 2mm between the base of the 1st and 2nd metatarsals suggest Lisfranc injury 4. On the lateral view, the superior border of the base of the first metatarsal should align with the superior border of the medial cuneiform 5. On the oblique view, the medial border of the fourth metatarsal should align with the medial border of the cuboid 6. A "fleck" sign on the AP view, or an avulsion off the base of the of the second metatarsal or medial cuneiform is a sign of a Lisfranc ligament* injury 7. CT and/or MRI have been advantageous in radiographically subtle Lisfranc injuries 2 Lisfranc Fracture Author: Russell Jones, MD