Lisfranc fractures

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  • 1. Lisfranc Injuries
  • 2. Anatomy  Tarso-metatarsal joint  Midfoot  Bones held in place by ligaments.  No ligament connection between 1st and 2nd metatarsals
  • 3. Mechanism of Injury  Direct trauma/crush  Twisting  Plantar flexion with axial loading  Low or high energy (beware of associated injuries)
  • 4. Mechanisms
  • 5. Clinical Presentation  Variable  Pain, especially with weight bearing activity  Plantar ecchymosis  Dorsal tenderness, edema  Mild discomfort  Deformity/instability  High index of suspicion based on mechanism!
  • 6. Diagnosis  Physical exam view X-Ray (AP, lateral, medial oblique)-weight- bearing films helpful.  20% of films are negative initially. Repeat films at 7-14 days, consider CT/MRI.  Often mistaken as a sprain-when in doubt, splint and refer to ortho.
  • 7. Fracture/dislocation findings  The most consistent finding is misalignment along the medial side of second MT and second cuneiform.
  • 8. Fracture/dislocation findings
  • 9. Fracture/dislocation findings  The medial cuneiform-second MT space should be evaluated for the "fleck sign" indicating avulsion of the Lisfranc ligament.
  • 10. Fleck Sign
  • 11. Classification  Homolateral  All of the metatarsals are dislocated to the same side  Usually involves the 2nd through 5th dislocated laterally  Divergent  May be associated with a fracture of the 1st cuneiform  Usually involves medial displacement of the 1st metatarsal and lateral displacement of 2nd-5th metatarsals
  • 12. Homolateral
  • 13. Classification  Homolateral  All of the metatarsals are dislocated to the same side  Usually involves the 2nd through 5th dislocated laterally  Divergent  May be associated with a fracture of the 1st cuneiform  Usually involves medial displacement of the 1st metatarsal and lateral displacement of 2nd-5th metatarsals
  • 14. Divergent
  • 15. Treatment  Depends on severity  RICE  If no dislocation--immobilize and no weight bearing for 4-8 weeks  If significant dislocation--closed reduction or ORIF
  • 16. Complications  Chronic pain secondary to posttraumatic osteoarthritis  Repeated injuries