Overview
What is Lisfranc fracture dislocation?
What is the anatomy of the Lisfranc joint relevant to Lisfranc fracture dislocation?
What is the pathophysiology of Lisfranc fracture dislocation?
What causes Lisfranc fracture dislocation?
What is the prevalence of Lisfranc fracture dislocation?
What is the prognosis of Lisfranc fracture dislocation?
What is included in patient education about Lisfranc fracture dislocation?
Presentation
What is the clinical presentation of Lisfranc fracture dislocation?
What are the signs and symptoms of Lisfranc fracture dislocation?
Which physical findings are characteristic of Lisfranc fracture dislocation?
What is the mechanism of injury for Lisfranc fracture dislocation in athletes?
How are Lisfranc fracture dislocations classified in athletes?
Workup
What is the role of lab testing in the diagnosis of Lisfranc fracture dislocation?
How frequently are Lisfranc fracture dislocations missed on initial presentation?
What is the role of plain radiography in the diagnosis of Lisfranc fracture dislocation?
What is the role of CT in the diagnosis of Lisfranc fracture dislocation?
What is the role of MRI in the diagnosis of Lisfranc fracture dislocation?
What is the role of bone scanning in the diagnosis of Lisfranc fracture dislocation?
What is the role of ultrasonography in the diagnosis of Lisfranc fracture dislocation?
What is the role of stress view imaging in the diagnosis of Lisfranc fracture dislocation?
What is the role of histology in the management of Lisfranc fracture dislocation?
How are Lisfranc fracture dislocations staged?
Treatment
How are Lisfranc fracture dislocations treated?
What is the role of acute fusion in the treatment of Lisfranc fracture dislocation?
What is the timing of screw removal in the treatment of Lisfranc fracture dislocation?
What is the role of suture button fixation in the treatment of Lisfranc fracture dislocation?
What is the role of casting in the treatment of Lisfranc fracture dislocation?
What is the role of surgery in the treatment of Lisfranc fracture dislocation?
How are Lisfranc fracture dislocation variations treated?
How is surgery performed for the treatment of Lisfranc fracture dislocation?
What is the role of plate fixation in the treatment of Lisfranc fracture dislocation?
What is the postoperative care following surgery for Lisfranc fracture dislocation?
What are the possible complications of Lisfranc fracture dislocation?
How is chronic pain managed following treatment for Lisfranc fracture dislocation?
What is included in the long-term monitoring of patients with Lisfranc fracture dislocation?
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Radiograph illustrating diabetic patient with first ray instability of the right foot. The articular surfaces of the second and first metatarsal are level in the transverse plane, indicating proximal migration of the first ray. The left foot shows the advanced stage of an untreated Lisfranc injury with similar first ray instability.
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Clinical identification of typical plantar ecchymosis pattern observed in Lisfranc injuries.
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In this anteroposterior radiograph of a Lisfranc dislocation, note the disruption of the normal second tarsometatarsal alignment.
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In this lateral radiograph of a typical Lisfranc injury, note the malalignment of the metatarsal bases with the midfoot.
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In this medial oblique radiograph of a normal foot, note the medial borders of the cuboid and fourth metatarsal base. They should be even, as depicted by the black lines.
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In this medial oblique radiograph of a Lisfranc injury, note the loss of alignment between the cuboid and fourth metatarsal base (black lines). This is diagnostic of a Lisfranc injury and is as important as recognition of the second tarsometatarsal instability.
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Stress view. This patient, with a suspected Lisfranc injury, presents with a normal appearing anteroposterior radiograph of the foot. Plantar ecchymosis and clinical presentation of pain warrant further investigation. In this radiograph, alignment of the medial border of the second metatarsal and the medial cuneiform is near normal. Patient is unable to bear weight due to a femur fracture sustained in the same accident.
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In this stressed view, with adequate anesthesia to the patient, the foot is stressed in a medial/lateral plane. The forefoot is forced laterally with the hindfoot brought medially. Note that the second tarsometatarsal joint opens up, and the normal alignment between the medial border of the second metatarsal base and the middle cuneiform is distorted. This injury requires surgical stabilization.
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Standard anteroposterior radiograph demonstrates a Lisfranc fracture dislocation. Determining the extent of fracture involving the joint is difficult with plain radiographs.
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CT scan in the coronal plane can demonstrate the extent of injury at the joint. Compare with the plain radiograph of this injury in the related image. Note the plantar avulsion, suggesting severe disruption of the plantar ligamentous structures.
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This diagram depicts the suggested fixation order of placement and alignment of screws for surgical fixation of unstable Lisfranc injuries.
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Preoperative anteroposterior radiograph demonstrates a Lisfranc dislocation.
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Preoperative lateral radiograph demonstrates a Lisfranc dislocation.
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Postoperative anteroposterior radiograph demonstrates reduction and fixation of Lisfranc dislocation.
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Postoperative lateral radiograph illustrates placement of fixation screws for stabilization of Lisfranc joint.
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Preoperative anteroposterior radiograph demonstrates a Lisfranc injury with proximal tarsal instability. The medial cuneiform is displaced medially, bringing the joint line level with the second. The proximal anatomy must be restored and stabilized before addressing the tarsometatarsal joint.
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Postoperative anteroposterior radiograph demonstrates restoration of normal midfoot alignment. Screw fixation was used to stabilize the cuneiform prior to realigning the Lisfranc joint. Due to comminution of the second and third metatarsal shafts, Kirschner wires were used to hold their position. In this case, due to continued instability, a wire through the fourth tarsometatarsal joint was also used.
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Preoperative anteroposterior radiograph demonstrates a Lisfranc injury with associated distal fracture. Note the displacement of the base of the first metatarsal.
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Postoperative anteroposterior radiograph demonstrates fixation of the metatarsal, as well as stabilization of the Lisfranc joint.
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Preoperative anteroposterior radiograph demonstrates a missed old Lisfranc injury with subsequent valgus foot deformity and painful weight bearing throughout the midfoot.
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Preoperative lateral radiograph demonstrates loss of plantar integrity through Lisfranc joint area. The normal linear alignment of the bones from the metatarsal to the talus is lost, with a sag at the tarsometatarsal joint.
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In this postoperative anteroposterior radiograph demonstrating reduction of Lisfranc alignment and screw configuration for tarsometatarsal fusion, note that only the medial 3 joints are fused. The lateral 2 joints remain mobile and actually open up when compared with the previous pictures.
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Postoperative lateral radiograph demonstrates restoration of alignment with tarsometatarsal fusion.