Lisfranc injury

Definition

...any fracture or dislocation of the TMT joint.

Epidemiology

20% are missed on first presentation to the ER.

<1% of all orthopedic trauma cases

Up to one third of all lisfranc inuries are from minor slip and fall cases...

Pathophysiology

The Lisfranc ligament attaches the second metatarsal to the medial cuboid.

Diagnosis

Clinical presentation is variable, includes severe midfoot pain, inability to bear weight, pain with pronation and passive abduction of the midfoot.

Ecchymosis of the plantar section of the midfoot is highly suggestive of Lissfrank injury...

Dx

Radiographic criteria:

Fracture of the base of the second metatarsal is pathonognmonic.

Stein's Criteria for Lisfranc injury:

1)The medial border of the fourth metatarsal does not form a continuous line with the medial border of the cuboid.

2)The lateral border of the third metatarsal does not form a straight line with the lateral border of the lateral cuneiform.

3)On AP view the medial border of the second metatarsal does not form a continuous straight line with the medial border of the middle cuneiform.

4)The first metatarsal does not align itself medially and laterally with the medial cuneifom.

• Have suspicion whenever there is any widening of the spaces between the first and second or second and third matarsal bases.

Treatment

Other than Lisfranc sprains (clinical findings but normal radiographs) which are treated ith 6 weeks of casting, all Lisfranc injuries require operative repair...