Diagnostics
Orthopedic pitfalls in the ED: Lisfranc fracture-dislocation*,**,*

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Abstract

Lisfranc fracture-dislocation of the foot is an injury that carries a high incidence of chronic pain and disability. Its emergency department presentation can be subtle, and more frequent than previously believed. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner. (Am J Emerg Med 2001;19:71-75. Copyright © 2001 by W.B. Saunders Company)

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).

. Dorsal AP view of the foot, showing the Lisfranc joint complex. Note the alignment of the second metatarsal with the second cuneiform, and its “keystone” wedging into the 3 cuneiforms. Illustration by Marsha J. Dohrman. Reprinted with permission from Burroughs KE,

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

  • Any foot with pain and swelling following trauma must be suspected of having a Lisfranc fracture/dislocation.

  • The anatomic relationship of the tarsal/metatarsal joint should be examined carefully in any patient with a suspicious history and/or physical examination

  • A fracture at the base of a metatarsal bone should heighten the suspicion for a Lisfranc joint injury.

  • A delay in the diagnosis or treatment of a Lisfranc fracture/dislocation can result in long-term morbidity of pain, arthrosis, and

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There are more references available in the full text version of this article.

Cited by (36)

  • Acute midfoot injuries and their management

    2018, Orthopaedics and Trauma
    Citation 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.

  • Turco's injury: Diagnosis and treatment

    2014, Revista Brasileira de Ortopedia
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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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0735-6757/01/1901-0019$10.00/0

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