Table of Contents
Lis Franc Injuries
Introduction
MOI
Anatomy
Injury patterns
X-ray assessment
See also
Source
History
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