A 28-year-old man falls forward onto a planted foot during sport. Weight-bearing radiographs of the midfoot show a small bony fragment lying between the base of the first and second metatarsals, described as the fleck sign. This sign indicates:
- A Avulsion of the Lisfranc ligament from the base of the second metatarsal ✓
- B Fracture of the cuboid with compression failure
- C Osteochondral loose body from the navicular
- D Calcification of the plantar fascia origin
Correct answer: A. Avulsion of the Lisfranc ligament from the base of the second metatarsal
Explanation
The fleck sign is pathognomonic of a tarsometatarsal (Lisfranc) joint disruption. It represents an avulsion fracture at the attachment of the Lisfranc ligament, the strong oblique band running from the lateral aspect of the medial cuneiform to the base of the second metatarsal. Its presence confirms instability that generally requires operative fixation rather than conservative care.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.