DiagnosticsOrthopedic pitfalls in the ED: Lisfranc fracture-dislocation*,**,*
Section snippets
Case 1
A 30-year-old man presented to the emergency department with a complaint of left foot pain. He related that he had jumped from a boat to a dock from a height of approximately 8 feet. He landed primarily on the left foot, and had no other complaints.
Examination of the left foot revealed moderate swelling over the dorsum of the midfoot, and exquisite tenderness to palpation. He could weight-bear only with significant pain. The skin was intact, and his neurovascular examination was normal.
Pathophysiology
Lisfranc injuries can be caused by either direct or indirect trauma. Direct or crush injuries to the dorsum of the foot are rare and are often complicated by contamination, vascular compromise, and compartment syndrome.5 The displacement of the metatarsal bases may occur in either the plantar or dorsal direction depending on the direction of force at the time of injury; and no distinctive pattern of injury exists for this mechanism. Indirect forces constitute the vast majority of injuries,
Diagnosis
Proper radiographic evaluation and interpretation of the foot is the key to diagnosis of Lisfranc injuries. A knowledge of the normal anatomic relationships at the Lisfranc joint is vital to radiographic interpretation (see Fig 5).
Treatment
Early diagnosis of a Lisfranc joint injury is imperative for proper management and the prevention of a poor functional outcome.1, 2, 3, 4, 6, 8 The definitive treatment of these fractures usually involves surgical intervention, although there is some controversy in the literature in this regard.2, 9, 16 The physician's responsibility in the emergency department is to suspect the diagnosis, confirm the injury radiographically, and to recognize the potential compartment syndrome, which may be
Key points for lisfranc fracture/dislocation
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Any foot with pain and swelling following trauma must be suspected of having a Lisfranc fracture/dislocation.
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The anatomic relationship of the tarsal/metatarsal joint should be examined carefully in any patient with a suspicious history and/or physical examination
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A fracture at the base of a metatarsal bone should heighten the suspicion for a Lisfranc joint injury.
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A delay in the diagnosis or treatment of a Lisfranc fracture/dislocation can result in long-term morbidity of pain, arthrosis, and
References (16)
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Dislocations and fracture dislocations of the tarsometatarsal joints
Orthop Clin North Am
(1987) - et al.
Lisfranc injury of the foot: A commonly missed diagnosis
Am Fam Phys
(1999) - et al.
Surgical management of acute tarsometatarsal fracture dislocation in the adult
Clin Orthop
(1998) - et al.
The treatment of Lisfranc injuries
Acta Orthop Belg
(1997) Lisfranc dislocation and associated metatarsophalangeal joint dislocations. A case report and literature review
Am J Orthop
(1996)- et al.
Lisfranc fracture dislocation: A frequently missed diagnosis in the emergency department
Ann Emerg Med
(1995) - et al.
Lisfranc's fracture dislocations: Etiology, radiology, result of treatment
Clin Orthop
(1983) - et al.
Lisfranc joint injuries: Trauma mechanisms and associated injuries
J Trauma
(1993)
Cited by (36)
Mid-term Incidence of Tarsometatarsal Joint Arthrodesis Following Open Reduction With Internal Fixation (ORIF) of Lisfranc Injuries
2024, Journal of Foot and Ankle SurgeryRetrospective chart review: Weightbearing CT scans and the measurement of the Lisfranc ligamentous complex
2023, Foot and Ankle SurgeryAcute midfoot injuries and their management
2018, Orthopaedics and TraumaCitation Excerpt :The foot should be neurovascularly examined as damage to the dorsal neurovascular bundle is possible. Foot compartment syndrome is rather rare.28,33 The initial radiographic evaluation of this injury consists of plain antero-posterior, 30o oblique and lateral non-weight bearing plain radiographs.
Foot and Ankle Surgery: Common Problems and Solutions
2018, Clinics in Sports MedicineTurco's injury: Diagnosis and treatment
2014, Revista Brasileira de OrtopediaLisfranc Injury in the Athlete: Evidence Supporting Management from Sprain to Fracture Dislocation
2013, Foot and Ankle Clinics
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Address reprint requests to Andrew D. Perron, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Box 800699, University of Virginia Health System, Charlottesville, VA 22908. E-mail: [email protected]
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Am J Emerg Med 2001;19:71-75.
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