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 | ||
| Line 6: | Line 7: | ||
*Dorsalis pedis may be injured in severe dislocation | *Dorsalis pedis may be injured in severe dislocation | ||
==Epidemiology== | ===Epidemiology=== | ||
*20% are missed on first presentation to ED | *20% are missed on first presentation to ED | ||
*Up to 1/3 of | *Up to 1/3 of inuries are from minor slip/fall | ||
== | ==Clinical Features== | ||
*Inability to bear weight (especially on tiptoe) | *Inability to bear weight (especially on tiptoe) | ||
* | *Tenderness over tarsometatarsal region | ||
*Pain with pronation and passive abduction of the midfoot | *Pain with pronation and passive abduction of the midfoot | ||
*Ecchymosis of plantar section of midfoot is highly suggestive | *Ecchymosis of plantar section of midfoot is highly suggestive | ||
== | ==Differential Diagnosis== | ||
{{Foot and toe fractures DDX}} | |||
==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== | ==Treatment & Disposition== | ||
''Most Lisfranc fractures require eventual surgery'' | |||
{{General Fracture Management}} | |||
===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> | |||
[[Category: | ==Complications== | ||
*[[Compartment syndrome]] | |||
==See Also== | |||
*[[Foot and toe fractures]] | |||
==References== | |||
<references/> | |||
[[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