Lisfranc InjuriesLisfranc Injuries

AnatomyAnatomy

Tarso-metatarsal jointTarso-metatarsal joint

MidfootMidfoot

Bones held in place by Bones held in place by ligaments.ligaments.

No ligament connection No ligament connection between 1between 1stst and 2 and 2ndnd metatarsalsmetatarsals

Mechanism of InjuryMechanism of Injury

Direct trauma/crushDirect trauma/crush

Twisting Twisting

Plantar flexion with axial loadingPlantar flexion with axial loading

Low or high energy (beware of associated Low or high energy (beware of associated injuries)injuries)

MechanismsMechanisms

Clinical PresentationClinical Presentation

VariableVariablePain, especially with weight bearing activityPain, especially with weight bearing activityPlantar ecchymosisPlantar ecchymosisDorsal tenderness, edemaDorsal tenderness, edemaMild discomfortMild discomfortDeformity/instabilityDeformity/instability

High index of suspicion based on High index of suspicion based on mechanism!mechanism!

DiagnosisDiagnosis Physical exam Physical exam

view X-Ray (AP, lateral, medial oblique)-weight-view X-Ray (AP, lateral, medial oblique)-weight-bearing films helpful.bearing films helpful.

20% of films are negative initially. Repeat films 20% of films are negative initially. Repeat films at 7-14 days, consider CT/MRI.at 7-14 days, consider CT/MRI.

Often mistaken as a sprain-when in doubt, splint Often mistaken as a sprain-when in doubt, splint and refer to ortho.and refer to ortho.

Fracture/dislocation findingsFracture/dislocation findings

The most consistent finding is The most consistent finding is misalignment along the medial side of misalignment along the medial side of second MT and second cuneiform. second MT and second cuneiform.

Fracture/dislocation findingsFracture/dislocation findings

Fracture/dislocation findingsFracture/dislocation findings

The medial cuneiform-second MT space The medial cuneiform-second MT space should be evaluated for the "fleck sign" should be evaluated for the "fleck sign" indicating avulsion of the Lisfranc indicating avulsion of the Lisfranc ligament. ligament.

Fleck SignFleck Sign

ClassificationClassification

HomolateralHomolateral All of the metatarsals are dislocated to the same side All of the metatarsals are dislocated to the same side Usually involves the 2nd through 5th dislocated Usually involves the 2nd through 5th dislocated

laterallylaterally

DivergentDivergent May be associated with a fracture of the 1st May be associated with a fracture of the 1st

cuneiform cuneiform Usually involves medial displacement of the 1st Usually involves medial displacement of the 1st

metatarsal and lateral displacement of 2nd-5th metatarsal and lateral displacement of 2nd-5th metatarsals metatarsals

HomolateralHomolateral

ClassificationClassification

HomolateralHomolateral All of the metatarsals are dislocated to the same side All of the metatarsals are dislocated to the same side Usually involves the 2nd through 5th dislocated Usually involves the 2nd through 5th dislocated

laterallylaterally

DivergentDivergent May be associated with a fracture of the 1st May be associated with a fracture of the 1st

cuneiform cuneiform Usually involves medial displacement of the 1st Usually involves medial displacement of the 1st

metatarsal and lateral displacement of 2nd-5th metatarsal and lateral displacement of 2nd-5th metatarsals metatarsals

DivergentDivergent

TreatmentTreatment

Depends on severityDepends on severity

RICERICE

If no dislocation--immobilize and no weight If no dislocation--immobilize and no weight bearing for 4-8 weeksbearing for 4-8 weeks

If significant dislocation--closed reduction or If significant dislocation--closed reduction or ORIFORIF

ComplicationsComplications

Chronic pain secondary to posttraumatic Chronic pain secondary to posttraumatic osteoarthritis osteoarthritis

Repeated injuriesRepeated injuries