=====Lis Franc Injuries=====

====Introduction====
  * Lis Franc joint - TMTJ
  * up to 20% missed --> sequelae of pain and OA
    * study radiographs with care
  * Treatment goal
    * anatomical reduction
    * stable 1-3 cuneiform-metatarsal joints
  * Current controversies
    * ORIF vs arthrodesis
    * Plate or transarticular Screws/wires
    * Approach - two dorsal incisions vs single incisions

====MOI====

  * High E or low E
  * Low energy lesions hard to miss - midfoot pain, plantar hematoma
  

====Anatomy====
  * 3 cuneiforms & 1 cuboid --> 5 MT
  * 4 and 5 MT mobile
  * 3 cuneiforms -- "Roman arch"
  * lis franc ligament - 1C to 2MT --> lisfranc ligament complex
  
==== Injury patterns ====
  * Quenu and Kuss 1909 -> Hardcastle 1982, Myerson

====X-ray assessment====
  * PA: 2MT and 2C alignment; fleck sign
  * oblique: 4MT and 3C
  * Lat: dorsal translation of MTs

=== Non-surgical treatment====
  * Lisfranc ligament sprains - stable and non-displaced
  * plaster boot NWB 6/52

===Surgical====
  * consider fasciotomy and temp wire/ex-fix first
  * Definitive surgery after 10-15 days (with wrinkling sign)
  * 2 incision approach
    * reduce and fix 1C to 1M
    * reduce 2C to 2M
    * fix 1C to 2M
    * fix 2C to 2M
    * then move ulnarly -- 2x screws, or 1 screw/1 wire for 3C/3T
    * then wires for 4th and 5th
  
====See also====

====Source====

  - Lisfranc fracture-dislocations: current managementInmaculada Moracia-Ochagavía and E. Carlos Rodríguez-Merchán. EFORT Open Reviews 2019 4:7, 430-444

====History====

  * created 2021-06-11