What radiographic finding is indicative of a Lisfranc fracture/dislocation?

The fleck sign is a critical radiographic finding associated with Lisfranc injuries. It indicates the presence of small bony fragments that occur at the site of the ligamentous attachment in the midfoot region, typically near the first and second metatarsal bases. This sign is indicative of a fracture or injury to the Lisfranc joint complex, highlighting the disruption of the normal anatomy and the potential for significant underlying injury.

In the context of Lisfranc injuries, recognizing the fleck sign is crucial as it can aid in diagnosing either subtle fractures or dislocations that may otherwise be overlooked on initial imaging. The presence of the fleck sign helps to confirm the diagnosis of a Lisfranc injury, guiding appropriate management and treatment strategies.

Other findings, such as narrowing between the first and second metatarsals or fractures of the fibula, are not as specific to Lisfranc injuries. Similarly, dislocation of the fifth digit does not have a direct correlation with the Lisfranc injury pattern, thereby underscoring the significance of identifying the fleck sign when evaluating suspected cases.