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md:ortho:lisfranc
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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
md/ortho/lisfranc.txt · Last modified: 2021/06/11 08:01 by admin
