Lisfranc injury: Difference between revisions
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Revision as of 01:13, 24 July 2017
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
- 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
Complications
- Must rule-out compartment syndrome