Lisfranc injury: Difference between revisions

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==Definition==
==Background==
[[File:Foot_Bones.jpg|thumb|Bones of the foot.]]
*Lisfranc Injury = any fracture 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 inuries are from minor slip/fall


...any fracture or dislocation of the TMT joint.
==Clinical Features==
*Inability to bear weight (especially on tiptoe)
*Tenderness over tarsometatarsal region
*Pain with pronation and passive abduction of the midfoot
*Ecchymosis of plantar section of midfoot is highly suggestive


==Differential Diagnosis==
{{Foot and toe fractures DDX}}


==Epidemiology==
==Evaluation==
[[File:Lisfranc.jpg|thumb|Lisfranc injury]]
''Fracture of base of second metatarsal is pathognomonic''
*AP
**Medial margin of 2nd metatarsal base does not align with medial margin of 2nd cuneiform
**Bony displacement 1mm or greater between bases of first and second metatarsals is considered unstable
*Oblique
**Medial margin of 3rd metatarsal does not align with medial margin of 3rd cuneiform
*Lateral
**2nd metatarsal is higher than middle cuneiform (step-off)


==Treatment & Disposition==
''Most Lisfranc fractures require eventual surgery''
{{General Fracture Management}}


20% are missed on first presentation to the ER.
===Specific Management===
*Sprains and non-displaced fractures:
**Non-weightbearing splint with ortho follow up (most managed with cast x 6 weeks)
**[[Posterior Ankle Splint]]
*Displaced fractures:
**Emergent ortho consult
**When diagnosed appropriately, patients who undergo open reduction and internal fixation of fractures have superior outcomes to those with purely ligamentous injury.<ref>Sherief, T et al. Lisfranc injury: How frequently does it get missed? And how can we improve?  Injury: International Journal of the Care of the Injured 2007: 34; 856-860. PMID: 17214988</ref>


<1% of all orthopedic trauma cases
==Complications==
*[[Compartment syndrome]]


Up to one third of all lisfranc inuries are from minor slip and fall cases...
==See Also==
*[[Foot and toe fractures]]


==References==
 
<references/>
==Pathophysiology==
[[Category:Orthopedics]]
 
 
The Lisfranc ligament attaches the second metatarsal to the medial cuboid.
 
 
==Diagnosis==
 
 
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:
 
1)The medial border of the fourth metatarsal does not form a continuous line with the medial border of the cuboid.
 
2)The lateral border of the third metatarsal does not form a straight line with the lateral border of the lateral cuneiform.
 
3)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.
 
4)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==
 
 
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]]

Latest revision as of 20:55, 22 March 2023

Background

Bones of the foot.
  • Lisfranc Injury = any fracture 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 inuries are from minor slip/fall

Clinical Features

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

Differential Diagnosis

Foot and Toe Fracture Types

Hindfoot

Midfoot

Forefoot

Evaluation

Lisfranc injury

Fracture of base of second metatarsal is pathognomonic

  • AP
    • Medial margin of 2nd metatarsal base does not align with medial margin of 2nd cuneiform
    • Bony displacement 1mm or greater between bases of first and second metatarsals is considered unstable
  • Oblique
    • Medial margin of 3rd metatarsal does not align with medial margin of 3rd cuneiform
  • Lateral
    • 2nd metatarsal is higher than middle cuneiform (step-off)

Treatment & Disposition

Most Lisfranc fractures require eventual surgery

General Fracture Management

Specific Management

  • Sprains and non-displaced fractures:
  • Displaced fractures:
    • Emergent ortho consult
    • When diagnosed appropriately, patients who undergo open reduction and internal fixation of fractures have superior outcomes to those with purely ligamentous injury.[1]

Complications

See Also

References

  1. ↑ Sherief, T et al. Lisfranc injury: How frequently does it get missed? And how can we improve? Injury: International Journal of the Care of the Injured 2007: 34; 856-860. PMID: 17214988
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