A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal.
• Diagosis is confirmed by radiographs which may show widening of the interval between the 1st and 2nd ray.
• Treatment is generally operative with either ORIF or arthrodesis.
Science
• Epidemiology
◦ incidence
account for 0.2% of all fractures
◦ demographics
more common in the third decade
males > females
• Pathophysiology
◦ mechanism of injury
MVAs, falls from height, and athletic injuries
mechanism is usually caused by indirect rotational forces and axial load through hyperplantar flexed forefoot
hyperflexion/compression/abduction moment exerted on forefoot and transmitted to the TMT articulation
metatarsals displaced in dorsal/lateral direction
◦ pathoanatomy
unifying factor is disruption of the TMT joint complex
injuries can range from mild sprains to severe dislocations
may take form of purely ligamentous injuries or fracture-dislocations
ligamentous vs. bony injury pattern has treatment implications
• Associated conditions
◦ proximal metatarsal fractures or tarsal fractures
Lisfranc equivalent injuries can present in the form of contiguous proximal metatarsal fractures or tarsal fractures
can involve multiple TMT joints
• Prognosis
◦ significant variability regarding return to full activity given heterogenous group of patients in nearly all studies
in the military population, at ~3 year follow-up, ~70% patients undergoing ORIF or primary arthrodesis were able to resume occupationally required daily running.
◦ missed injuries can result in progressive foot planovalgus deformity, chronic pain and dysfunction
tarsometatarsal fracture-dislocations are easily missed and diagnosis is critical