Lisfranc injury: Difference between revisions

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==Treatment & Disposition==
==Treatment & Disposition==
''Most Lisfranc fractures require eventual surgery''
''Most Lisfranc fractures require eventual surgery''
{{General Fracture Management}}
===Specific Management===
*Sprains and non-displaced fractures:
*Sprains and non-displaced fractures:
**Non-weightbearing splint with ortho follow up (most managed with cast x 6 weeks)
**Non-weightbearing splint with ortho follow up (most managed with cast x 6 weeks)
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*Displaced fractures:
*Displaced fractures:
**Emergent ortho consult
**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>


==Complications==
==Complications==
*Must rule-out compartment syndrome
*[[Compartment syndrome]]


==See Also==
==See Also==
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==References==
==References==
 
<references/>
[[Category:Orthopedics]]
[[Category:Orthopedics]]

Revision as of 05:15, 18 September 2019

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 Fracture Types

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

General Fracture Management

Specific Management

  • 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

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