Nunley-Vertullo classification

Last revised by Andrew Murphy on 9 May 2022

The Nunley-Vertullo classification is one of several classification systems used for the categorization of Lisfranc injuries. It is based on clinical, x-ray and bone scan findings and also associates the stages with management options or recommendations regarding those injuries 1-3.

The Nunley-Vertullo classification system is used for the grading of more subtle Lisfranc injuries or midfoot sprains and utilizes the following parameters 1-3:

  • midfoot pain, inability to participate in sports
  • no displacement on weight-bearing radiographs
  • positive bone scan
  • indicates ligament sprain
  • diastasis of 1-5 mm between the first and second metatarsal base
  • no decline of the medial longitudinal arch
  • indicates a subtle ligament injury
  • diastasis of ≥5 mm between the first and second metatarsal base
  • loss of medial longitudinal arch height (decline in distance between the medial cuneiform and fifth metatarsal)
  • indicates a more severe injury

Based on the classification the authors recommended conservative non-operative management for type 1 injuries and anatomical reduction and fixation for type 2 and type 3 injuries 2,3.

This classification system was developed by the American orthopedic surgeons James A Nunley and Christopher J Vertullo in 2002 1.

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Cases and figures

  • Figure 1: Nunley-Vertullo classification - illustrations
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  • Figure 2: Nunley-Vertullo classification of Lisfranc injuries (illustrations)
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