Lisfranc injury: Difference between revisions
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==Complications== | ==Complications== | ||
*Must rule-out compartment syndrome | *Must rule-out compartment syndrome | ||
==See Also== | |||
*[[Fractures (Main)]] | |||
==Source== | ==Source== | ||
Revision as of 00:38, 1 May 2012
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
- 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
Imaging
- Fx of base of second metatarsal is pathognomonic
- AP
- Medial margin of 2nd metatarsal base doesn't align w/ 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
- Sprains and non-displaced fractures:
- Non-weightbearing splint w/ ortho f/u (most pts managed w/ cast x6wk)
- Displaced fractures:
- Emergent ortho consult
- Most Lisfranc fractures require surgery
Complications
- Must rule-out compartment syndrome
See Also
Source
- Tintinalli