A 30-year-old man falls from a height onto his plantarflexed foot. He has midfoot pain and swelling. Weight-bearing radiographs show a small bony avulsion fragment in the interval between the medial cuneiform and the base of the second metatarsal, with 4 mm of diastasis at that interval. This pathognomonic fragment is called:

• A Dot sign
• B Fleck sign ✓
• C Segond fragment
• D Pillow sign

Explanation

The fleck sign is an avulsion fracture of the Lisfranc ligament insertion, typically off the base of the second metatarsal or medial cuneiform, and is considered pathognomonic of a Lisfranc injury. Diastasis greater than 2 mm mandates surgical reduction and fixation or primary fusion. B Segond fragment is a lateral tibial plateau avulsion associated with ACL rupture, a knee finding unrelated to the midfoot.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.