Lisfranc injury

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Lisfranc injury
Other namesLisfranc fracture, Lisfranc dislocation, Lisfranc fracture dislocation, tarsometatarsal injury, midfoot injury
Orthopedics

A Lisfranc injury, also known as Lisfranc fracture, is an

displaced from the tarsus.[1][2]

The injury is named after Jacques Lisfranc de St. Martin, a French surgeon and gynecologist who noticed this fracture pattern amongst cavalrymen in 1815, after the War of the Sixth Coalition.[3]

Causes

Lisfranc ligaments:[4]
C1 = Medial cuneiform
M2 = 2nd metatarsal base
M3 = 3rd metatarsal base
Red = dorsal Lisfranc ligament
Blue = interosseous Lisfranc ligament
Green = plantar Lisfranc ligament.

The

metatarsal bones. It is these articulations that are damaged in a Lisfranc injury. Such injuries typically involve the ligaments between the medial cuneiform bone and the bases of the second and third metatarsal bones, and each of these ligaments is called Lisfranc ligament.[4]

Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents.[5]

Direct Lisfranc injuries are usually caused by a crush injury, such as a heavy object falling onto the midfoot, or the foot being run over by a car or truck, or someone landing on the foot after a fall from a significant height.

plantar flexed (downward pointing) forefoot.[5] Examples of this type of trauma include a rider falling from a horse but the foot remaining trapped in the stirrup, or a person falling forward after stepping into a storm drain.[6]

In athletic trauma, Lisfranc injuries occur commonly in activities such as

kitesurfing, wakeboarding, or snowboarding (where appliance bindings pass directly over the metatarsals).[7] American football players occasionally acquire this injury, and it most often occurs when the athlete's foot is plantar flexed and another player lands on the heel. This can also be seen in pivoting athletic positions such as a baseball catcher or a ballerina spinning.[citation needed
]

Diagnosis

metatarsal bones
.

In a high energy injury to the midfoot, such as a fall from a height or a motor vehicle accident, the diagnosis of a Lisfranc injury should, in theory at least, pose less of a challenge. There will be deformity of the midfoot and X-ray abnormalities should be obvious. Further, the nature of the injury will create heightened clinical suspicion and there may even be disruption of the overlying skin and compromise of the blood supply. Typical X-ray findings would include a gap between the base of the first and second toes.

computed tomography (CT scan) is a logical next step.[11]

Classification

There are three classifications for the fracture:[12]

  1. Homolateral: All five metatarsals are displaced in the same direction. Lateral displacement may also suggest cuboidal fracture.
  2. Isolated: one or two metatarsals are displaced from the others.
  3. Divergent: metatarsals are displaced in a
    intercuneiform area and include a navicular
    fracture.

Treatment

Options include operative or non-operative treatment. One study claims that in athletes, and if the dislocation is less than 2 mm, the fracture can be managed with casting for six weeks.[13] The person's injured limb cannot bear weight during this period. In the majority of cases, early surgical alignment of bone fragments to their original anatomical position (open reduction) and stable fixation is indicated.[14] A 2005 study suggests that closed reduction and Kirschner wire (K-wire) stabilisation or open reduction and stabilisation - generally using screws to avoid the complication of K-wires and maintain a stable reduction - are the treatments of choice.[14]

According to a 1997 study, for severe Lisfranc injuries, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire fixation is the treatment of choice.[15] The foot cannot be allowed to bear weight for a minimum of six weeks. Partial weight-bearing may then begin, with full weight bearing after an additional several weeks, depending on the specific injury. K-wires are typically removed after six weeks, before weight bearing, while screws are often removed after 12 weeks.[15]

When a Lisfranc injury is characterized by significant displacement of the tarsometatarsal joint(s), nonoperative treatment often leads to severe loss of function and long-term disability secondary to chronic pain and sometimes to a planovalgus deformity. In cases with severe pain, loss of function, or progressive deformity that has failed to respond to nonoperative treatment, mid-tarsal and tarsometatarsal arthrodesis (operative fusion of the bones) may be indicated.[16]

History

During the

tarsometatarsal joints,[3] and that area of the foot has since been referred to as the namesake "Lisfranc joint".[17] Although Lisfranc did not describe a specific mechanism of injury or classification scheme, a Lisfranc injury has come to mean a dislocation or fracture-dislocation injury at the tarsometatarsal joints.[18]

See also

References

  1. Who Named It?
  2. ^ "Lisfranc's fracture". The Free Dictionary.
  3. ^ a b c Lisfranc J (1815). Nouvelle méthode opératoire pour l'amputation partielle du pied dans son articulation tarso-métatarsienne: méthode précédée des nombreuses modifications qu'a subies celle de Chopart (in French). Paris: L'imprimerie de Feuguery. pp. 1–52.
  4. ^
    PMID 23453037
    .
  5. ^
    S2CID 35856985
    .
  6. ^ a b Chan S, Chow SP (2001). "Current concept review on Lisfranc injuries" (PDF). Hong Kong Journal of Orthopaedic Surgery. 5 (1): 75–80. Archived from the original (PDF) on 2016-03-04. Retrieved 2012-06-05.
  7. PMID 27278743
    .
  8. S2CID 33610199
    .
  9. PMID 8932671
    .
  10. PMID 22451574
    .
  11. PMID 19038612
    .
  12. ^ Wheeless CR (2011). "Lisfranc's Fracture / TarsoMetatarsal Injuries". Wheeless' Textbook of Orthopaedics online. Durham, North Carolina: Duke Orthopaedics. Retrieved 2012-06-05.
  13. S2CID 41073329
    .
  14. ^
    doi:10.1016/j.cuor.2004.12.008.[permanent dead link
    ]
  15. ^
    PMID 9265792. Archived from the original
    (PDF) on 2013-11-05.
  16. S2CID 20769992. Archived from the original
    on 2012-12-13. Retrieved 2012-06-06.
  17. Who Named It?
  18. PMID 22424486. Archived from the original
    (PDF) on 2016-03-04. Retrieved 2012-06-05.

External links

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