Lisfranc injury: Difference between revisions
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==Background== | ==Background== | ||
*Lisfranc Injury = any | [[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 | *Lisfranc ligament attaches 2nd metatarsal to medial cuneiform | ||
**2nd metatarsal is held in mortice created by the three cuneiform bones | **2nd metatarsal is held in mortice created by the three cuneiform bones | ||
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{{Foot and toe fractures DDX}} | {{Foot and toe fractures DDX}} | ||
== | ==Evaluation== | ||
[[File:Lisfranc.jpg|thumb|Lisfranc injury]] | [[File:Lisfranc.jpg|thumb|Lisfranc injury]] | ||
''Fracture of base of second metatarsal is pathognomonic'' | |||
*AP | *AP | ||
**Medial margin of 2nd metatarsal base | **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 | **Bony displacement 1mm or greater between bases of first and second metatarsals is considered unstable | ||
*Oblique | *Oblique | ||
**Medial margin of 3rd metatarsal | **Medial margin of 3rd metatarsal does not align with medial margin of 3rd cuneiform | ||
*Lateral | *Lateral | ||
**2nd metatarsal is higher than middle cuneiform (step-off) | **2nd metatarsal is higher than middle cuneiform (step-off) | ||
==Treatment & Disposition== | ==Treatment & Disposition== | ||
''Most Lisfranc fractures require eventual surgery'' | |||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Sprains and non-displaced fractures: | *Sprains and non-displaced fractures: | ||
**Non-weightbearing splint with ortho | **Non-weightbearing splint with ortho follow up (most managed with cast x 6 weeks) | ||
**[[Posterior Ankle Splint]] | **[[Posterior Ankle Splint]] | ||
*Displaced fractures: | *Displaced fractures: | ||
**Emergent ortho consult | **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> | ||
==Complications== | ==Complications== | ||
* | *[[Compartment syndrome]] | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 20:55, 22 March 2023
Background
- 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
- 2nd metatarsal is held in mortice created by the three cuneiform bones
- 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
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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
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.[1]
Complications
See Also
References
- ↑ 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