Lisfranc Injuries

Lisfranc Injuries

George F. Wallace

Lisfranc injuries are relatively uncommon, yet missed upward of 20% of the time (1). The incidence has been reported to be 1 per 55,000 and represents 0.2% of all fractures (2). Naturally, the injury occurs at the Lisfranc joint and has been historically designated precisely as a “Lisfranc fracture dislocation.”

Therefore, one can have a Lisfranc dislocation with or without a fracture. However, there can be any number of combinations of a fracture or fractures of one or numerous osseous segments comprising the Lisfranc articulation with a dislocation or dislocations. The Lisfranc joint is also called the tarsometatarsal joint comprising articulations of all five metatarsal bases with the distal three cuneiforms and cuboid articulations, respectively. Conventionally, injuries at the Lisfranc joint are designated as a Lisfranc fracture dislocation. When fractures are absent, then a Lisfranc dislocation can be listed as the diagnosis.

A few classifications have been proposed: Quenu and Kuss, Hardcastle, and the Myerson modification to the latter (3,4). None include any prognostic indicators. Moderate interrater reliability was demonstrated by Talarico et al (5) upon analysis of Hardcastle’s classification. Intuitively, however, the more joints disrupted, either by dislocation and/or fractures, the more severe the injury and the greater the potential for longterm sequelae (Table 116.1; Fig. 116.1). One need not have a fracture of the joint to initiate the classification scheme.

Two mechanisms of injury have been proposed: the “direct” due to a force applied at the Lisfranc joint, for example, a heavy object falling on the joint, and the “indirect” from forces applied resulting in plantarflexion and an amount of rotation at the Lisfranc joint (6). In either, the degree of force will determine if fractures are present along with the dislocation as the end result (Fig. 116.2).

As in all trauma, index of suspicion has to be present whether or not disruption of any part of the Lisfranc joint has occurred. The joints may be aligned due to spontaneously reducing without evidence of a fracture, but a cogent history and physical examination will most likely point the clinician toward the diagnosis. Stressing the joints may then be warranted.

Jul 26, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Lisfranc Injuries

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