Lisfranc Injuries: Case Presentation

Ryan Will MDOlympia Orthopaedic Associates

Olympia, WA

Disclosures

• I have nothing to disclose regarding commercial support

My Basic Approach

• 2 Roman Arches – transverse and longitudinal

• Requires Absolute Stability and Reduction

• Joints should not move

• I don’t typically fuse (it’s really hard)

Role of Gastrocnemius

• Ask pt’s about Hx of plantar fasciitis, flat feet, cavus feet, multiple chronic ankle sprains, bunions, calf cramps• Need to examine the

contralateral foot as well• 1st ray hypermobility, Silverskiold

test

• All of above pathology related to pre-existing gastroc contracture

Case – 65 yo female

• 1 week before consultation, pt was at doctor’s when she twisted and felt a pop in her foot. Unable to bear weight since. Admitted for other reasons• Complex PMH – currently with open ostomy for previous bowel

obstruction, pending reversal, COPD, fibromyalgia, might need TPN soon• States she has “flat feet” • Foot with expected swelling, extensive plantar ecchymosis• Contralateral foot with 1st ray hypermobility and positive Silverskiold

test

Initial Images

Steps I Take

• Gastroc recession vs Achilles perc lengthening (take the pressure off)• Make dual dorsal approach• Examine the Intercunieform joint and stabilize• Reduce 2nd TMT joint FIRST (keystone in building the arch)• Reduce 3rd TMT next then 1st TMT LAST• Hold each reduction with K-wires• Exchange sequentially for screws or plates depending on

comminution

Intraoperative Images

Intraoperative Images Cont

Intraoperative Images Cont

Follow Up Radiograph 6 months

Final Follow Up

• All wounds healed uneventfully• Pt able to ambulate

independently at 6 months• Denies much pain• No further surgery needed in

this case

• Final thoughts

• Look at the opposite foot• Think about the gastroc• Usually needs more than less

fixation• Fusion not normally needed