Lecture Notes: Lisfranc Injury

Overview

• Lisfranc Injury: Displacement of one or more metatarsal bones from the tarsus.
• Other Names: Lisfranc fracture, Lisfranc dislocation, tarsometatarsal injury, midfoot injury.
• Specialty: Orthopedics.

History

• Named after Jacques Lisfranc de St. Martin, a French surgeon noted this pattern of injury among cavalry soldiers in 1815.

Anatomy

• Midfoot: Contains five bones forming foot arches (cuboid, navicular, three cuneiform bones) with articulations with metatarsal bases.
• Lisfranc Ligaments:
  • C1 = Medial cuneiform
  • M2 = 2nd metatarsal base
  • M3 = 3rd metatarsal base
  • Dorsal Lisfranc ligament (red), Interosseous Lisfranc ligament (blue), Plantar Lisfranc ligament (green).

Injury Causes

• Kinetic Energy Impact: Often from traffic collisions or industrial accidents.
• Direct Injuries: Crush injuries from heavy objects, car accidents, falls from heights.
• Indirect Injuries: Rotational force on a plantar flexed forefoot, e.g., horse-riding falls.

Athletic Injuries

• Common in windsurfing, kitesurfing, wakeboarding, snowboarding.
• American football players: injury occurs with plantar flexion and additional force.

Diagnosis

• High-Energy Incidents: Obvious deformity, X-ray abnormalities.
• Low-Energy Incidents: Subtle signs, complaints of weight-bearing difficulty, mild swelling.
• Diagnostic Imaging:
  • Conventional radiography: standard and weight-bearing views.
  • MRI or CT scan if X-rays are inconclusive.

Classification

1. Homolateral: All metatarsals displaced in one direction.
2. Isolated: One or two metatarsals displaced from others.
3. Divergent: Metatarsals displaced in sagittal or coronal plane.

Treatment

• Non-Operative: Casting if dislocation is < 2mm.
• Operative: Surgical alignment and fixation.
  • Open Reduction Internal Fixation (ORIF) for severe cases.
  • K-wires and screws usage and timeline for removal.
• Severe displacement may require arthrodesis.

Rehabilitation

• Strengthening Exercises: Mobility training post-healing.
• EMS Foot Massagers: Supportive therapy to improve muscle activity and enhance blood flow.

Historical Context

• During Napoleonic Wars, Lisfranc first observed a soldier with vascular compromise leading to amputation at tarsometatarsal joints.

Additional Topics

• Related fractures: Bosworth, Chopart's fracture-dislocation, Jones fracture, March fracture.