Lisfranc injury

From WikEM
Jump to: navigation, search

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
  • 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 Fractures

Hindfoot

Midfoot

Forefoot

Evaluation

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 & Disposition

Most Lisfranc fractures require eventual surgery

  • Sprains and non-displaced fractures:
  • 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

  • Must rule-out compartment syndrome

See Also

References

  1. 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