PROCEDURE 38 Repair of Tarsometatarsal Joint (Lisfranc) Fracture-Dislocation
Indications
![image](/wp-content/uploads/2016/06/x25AA-6053.gif)
![image](/wp-content/uploads/2016/06/x25AA-6106.gif)
• These are defined as pain on weight bearing and palpation without any radiographic instability, and nondisplaced ligamentous injuries.
• The indications for nonoperative treatment include less than 2 mm of displacement in any plane and no joint line instability with weight-bearing or stress radiographs.
• These injuries can be treated in a short-leg non–weight-bearing cast for 6 weeks with repeat stress views 10 days postinjury.
Examination/Imaging
PHYSICAL EXAMINATION
![image](/wp-content/uploads/2016/06/x25AA-6204.gif)
![image](/wp-content/uploads/2016/06/x25AA-6254.gif)
IMAGING STUDIES
![image](/wp-content/uploads/2016/06/x25AA-6340.gif)
![image](/wp-content/uploads/2016/06/x25AA-6381.gif)
• Lateral (Fig. 2B)
♦ The second TMT joint aligns on its dorsal surface uninterrupted with the tarsal bone proximally and the MT base distally.
![image](/wp-content/uploads/2016/06/x25AA-6423.gif)
• Avulsion fractures around the TMT joint—the “fleck” sign: an avulsion of the medial base of the second MT from the attachment of the Lisfranc ligament, as seen in Case 1 (Fig. 3A and 3B)
![image](/wp-content/uploads/2016/06/x25AA-6460.gif)
• Displacement greater than 2 mm of widening between the bases of the first and second MTs is considered ligamentous compromise.
![image](/wp-content/uploads/2016/06/x25AA-6503.gif)
Surgical Anatomy
![image](/wp-content/uploads/2016/06/x25AA-6685.gif)
• The medial column is further divided into the medial and middle legs.
♦ The medial leg includes the first MT and medial cuneiform. This leg has three times more motion than the middle leg.
![image](/wp-content/uploads/2016/06/x25AA-6724.gif)
![image](/wp-content/uploads/2016/06/x25AA-6762.gif)
![image](/wp-content/uploads/2016/06/x25AA-6794.gif)
![image](/wp-content/uploads/2016/06/x25AA-6888.gif)
![](https://freepngimg.com/download/social_media/63059-media-icons-telegram-twitter-blog-computer-social.png)
Stay updated, free articles. Join our Telegram channel
![](https://clinicalpub.com/wp-content/uploads/2023/09/256.png)
Full access? Get Clinical Tree
![](https://videdental.com/wp-content/uploads/2023/09/appstore.png)
![](https://videdental.com/wp-content/uploads/2023/09/google-play.png)