Lisfranc injury: Difference between revisions
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*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}} | ||
==Diagnosis== | |||
[[File:Lisfranc.jpg|thumb|Lisfranc injury]] | |||
*Fracture of base of second metatarsal is pathognomonic | |||
*AP | *AP | ||
**Medial margin of 2nd metatarsal base doesn't align | **Medial margin of 2nd metatarsal base doesn't 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 doesn't align | **Medial margin of 3rd metatarsal doesn't 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== | |||
*Sprains and non-displaced fractures: | *Sprains and non-displaced fractures: | ||
**Non-weightbearing splint | **Non-weightbearing splint with ortho f/u (most managed with cast x6wk) | ||
**[[Posterior Ankle Splint]] | **[[Posterior Ankle Splint]] | ||
*Displaced fractures: | *Displaced fractures: | ||
| Line 45: | Line 44: | ||
*[[Foot and toe fractures]] | *[[Foot and toe fractures]] | ||
== | ==References== | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 13:54, 1 April 2016
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
Differential Diagnosis
Foot and Toe Fracture Types
Hindfoot
Midfoot
Forefoot
Diagnosis
- Fracture of base of second metatarsal is pathognomonic
- AP
- Medial margin of 2nd metatarsal base doesn't 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 doesn't align with medial margin of 3rd cuneiform
- Lateral
- 2nd metatarsal is higher than middle cuneiform (step-off)
Treatment & Disposition
- Sprains and non-displaced fractures:
- Non-weightbearing splint with ortho f/u (most managed with cast x6wk)
- Posterior Ankle Splint
- Displaced fractures:
- Emergent ortho consult
- Most Lisfranc fractures require surgery
Complications
- Must rule-out compartment syndrome