Lisfranc injury: Difference between revisions

Revision as of 23:08, 22 April 2011

Background

Lisfranc Injury = any fx or dislocation of the tarsal-metatarsal joint
Lisfranc ligament attaches 2nd metatarsal to medial cuneiform
- 2nd metatarsal is held in mortice created by the three cuneiform bones
  - Injury to 2nd metatarsal often results in dislocation of the other MTs
Dorsalis pedis may be injured in severe dislocation

Epidemiology

20% are missed on first presentation to ED
Up to 1/3 of all inuries are from minor slip/fall

Diagnosis

Inability to bear weight (especially on tiptoe)
TTP over tarsometatarsal region
Pain with pronation and passive abduction of the midfoot
Ecchymosis of plantar section of midfoot is highly suggestive

Imaging

Fx of base of second metatarsal is pathognomonic
AP: Medial margin of 2nd metatarsal base doesn't align w/ the medial margin of 2nd cuneiform
Oblique: Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
Lateral: 2nd metatarsal is higher than middle cuneiform (step-off)

Treatment

Lisfranc sprains (normal radiographs) can be managed non-operatively (6 weeks of casting)
Most Lisfranc fractures require surgery

Authors:

@@ Line 1: / Line 1: @@
-==Definition==
+==Background==
+*Lisfranc Injury = any fx or dislocation of the tarsal-metatarsal joint
+*Lisfranc ligament attaches 2nd metatarsal to medial cuneiform
-...any fracture or dislocation of the TMT joint.
+**2nd metatarsal is held in mortice created by the three cuneiform bones
+***Injury to 2nd metatarsal often results in dislocation of the other MTs
+*Dorsalis pedis may be injured in severe dislocation
 ==Epidemiology==
+*20% are missed on first presentation to ED
+*Up to 1/3 of all inuries are from minor slip/fall
-% are missed on first presentation to the ER.
-<1% of all orthopedic trauma cases
-Up to one third of all lisfranc inuries are from minor slip and fall cases...
-==Pathophysiology==
-The Lisfranc ligament attaches the second metatarsal to the medial cuboid.
 ==Diagnosis==
+*Inability to bear weight (especially on tiptoe)
+*TTP over tarsometatarsal region
+*Pain with pronation and passive abduction of the midfoot
+*Ecchymosis of plantar section of midfoot is highly suggestive
+==Imaging==
+*Fx of base of second metatarsal is pathognomonic
+*AP: Medial margin of 2nd metatarsal base doesn't align w/ the medial margin of 2nd cuneiform
+*Oblique: Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
+*Lateral: 2nd metatarsal is higher than middle cuneiform (step-off)
-Clinical presentation is variable, includes severe midfoot pain, inability to bear weight, pain with pronation and passive abduction of the midfoot.
-Ecchymosis of the plantar section of the midfoot is highly suggestive of Lissfrank injury...
-==Dx==
-Radiographic criteria:
-Fracture of the base of the second metatarsal is pathonognmonic.
-Stein's Criteria for Lisfranc injury:
-)The medial border of the fourth metatarsal does not form a continuous line with the medial border of the cuboid.
-)The lateral border of the third metatarsal does not form a straight line with the lateral border of the lateral cuneiform.
-)On AP view the medial border of the second metatarsal does not form a continuous straight line with the medial border of the middle cuneiform.
-)The first metatarsal does not align itself medially and laterally with the medial cuneifom.
-*Have suspicion whenever there is any widening of the spaces between the first and second or second and third matarsal bases.
 ==Treatment==
+*Lisfranc sprains (normal radiographs) can be managed non-operatively (6 weeks of casting)
+*Most Lisfranc fractures require surgery
-Other than Lisfranc sprains (clinical findings but normal radiographs) which are treated ith 6 weeks of casting, all Lisfranc injuries require operative repair...
 [[Category:Ortho]]