Lisfranc injury: Difference between revisions

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==Epidemiology==
==Epidemiology==
*20% are missed on first presentation to ED
*20% are missed on first presentation to ED
*Up to 1/3 of all inuries are from minor slip/fall
*Up to 1/3 of inuries are from minor slip/fall


==Diagnosis==
==Clinical Features==
*Inability to bear weight (especially on tiptoe)
*Inability to bear weight (especially on tiptoe)
*TTP over tarsometatarsal region
*Tenderness over tarsometatarsal region
*Pain with pronation and passive abduction of the midfoot
*Pain with pronation and passive abduction of the midfoot
*Ecchymosis of plantar section of midfoot is highly suggestive
*Ecchymosis of plantar section of midfoot is highly suggestive
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==Imaging==
==Imaging==
*Fx of base of second metatarsal is pathognomonic
*Fx of base of second metatarsal is pathognomonic
*AP: Medial margin of 2nd metatarsal base doesn't align w/ the medial margin of 2nd cuneiform
*AP
*Oblique: Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
**Medial margin of 2nd metatarsal base doesn't align w/ medial margin of 2nd cuneiform
*Lateral: 2nd metatarsal is higher than middle cuneiform (step-off)
*Oblique
 
**Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
*Lateral
**2nd metatarsal is higher than middle cuneiform (step-off)


==Treatment==
==Treatment==
*Lisfranc sprains (normal radiographs) can be managed non-operatively (6 weeks of casting)
*Sprains and non-displaced fractures:
**Non-weightbearing splint w/ ortho f/u (most pts managed w/ cast x6wk)
*Displaced fractures:
**Emergent ortho consult
*Most Lisfranc fractures require surgery
*Most Lisfranc fractures require surgery


==Complications==
*Must rule-out compartment syndrome
==Source==
*Tintinalli


[[Category:Ortho]]
[[Category:Ortho]]

Revision as of 23:54, 17 February 2012

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
  • 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

Imaging

  • Fx of base of second metatarsal is pathognomonic
  • AP
    • Medial margin of 2nd metatarsal base doesn't align w/ medial margin of 2nd cuneiform
  • Oblique
    • Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
  • Lateral
    • 2nd metatarsal is higher than middle cuneiform (step-off)

Treatment

  • Sprains and non-displaced fractures:
    • Non-weightbearing splint w/ ortho f/u (most pts managed w/ cast x6wk)
  • Displaced fractures:
    • Emergent ortho consult
  • Most Lisfranc fractures require surgery

Complications

  • Must rule-out compartment syndrome

Source

  • Tintinalli