Lisfranc injury

Lisfranc injuries, also called Lisfranc fracture-dislocations, are the most common type of dislocation involving the foot and correspond to the dislocation of the articulation of the tarsus with the metatarsal bases.

Pathology

Anatomy

The Lisfranc joint is the articulation of the tarsus with the metatarsal bases, whereby the first three metatarsals articulate respectively with the three cuneiforms, and the 4th and 5th metatarsals with the cuboid.

The Lisfranc ligament is a strong band attaching the medial cuneiform to the 2nd metatarsal base on the plantar aspect of the foot. Its integrity is crucial to the stability of the Lisfranc joint.

Mechanism

Injury mechanisms are varied and include direct crush injury, or an indirect load onto a plantar flexed foot 3. Tarsometatarsal dislocation may also occur in the diabetic neuropathic joint (Charcot).

Subtypes

There are several types of Lisfranc fracture-dislocation:

  • homolateral: a homolateral injury is a lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains congruent
  • divergent: a divergent injury is a lateral dislocation of the 2nd to 5th metatarsals with medial dislocation of the 1st metatarsal
  • isolated: this involves one or two metatarsals that dislocate dorsally in isolation

Radiographic features

Plain radiograph/CT

These injuries are well demonstrated on the standard views of the foot.

Ancillary imaging techniques are seldom required, although CT examination may show unsuspected associated fractures. 

Associated fractures most often occur at the base of the second metatarsal. They may also be seen in the 3rd metatarsal, 1st or 2nd cuneiform, or navicular bones. 

Ultrasound

Useful for assessing the ligamentous injury. Non-visualisation of the dorsal C1-M2 ligament and a C1-M2 distance >2.5 mm is indirectly indicative or a Lisfranc ligament tear 5.

Dynamic evaluation with weight bearing may show widening of the space between C1 and M2.

MRI

Again may be useful for assessing ligamentous injury especially when there is a high clinical concern with routine radiographs being inconclusive 7

Treatment and prognosis

Internal fixation is the most common treatment. 

Complications

The most common complications of ankle and foot fractures are non-union and post-traumatic arthritis. Although conventional radiography can usually demonstrate the features of these complications, CT is the better technique for delineating their details.

History and etymology

It is named after Jacques Lisfranc De Saint Martin (1790-1847), French surgeon 2.

Edit Article Share
URL of Article

Article Information

rID: 1590
System: Musculoskeletal
Section: Pathology
Synonyms or Alternate Spellings:
  • Lisfranc fracture
  • Lisfranc fracture-dislocation
  • Drag
    Normal Lisfranc a...
    Figure 1: normal Lisfranc joint alignment
    Drag here to reorder.
  • Drag
    Case 1: homolateral
    Drag here to reorder.
  • Drag
    Case 2: divergent
    Drag here to reorder.
  • Drag
    Homolateral Lisfr...
    Case 3: homolateral
    Drag here to reorder.
  • Drag
    Lisfranc’s disloc...
    Case 4: with Charcot's foot
    Drag here to reorder.
  • Drag
    Case 5
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Lisfranc injury

DP
    Case 8
    Drag here to reorder.
  • Drag
    Case 9: subtle - arrowed
    Drag here to reorder.
  • Drag
    Case 10
    Drag here to reorder.
  • Drag
    Case 11
    Drag here to reorder.
  • Drag
    Case 12
    Drag here to reorder.
  • Drag
    Case 13
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert_accept

    Error Unable to process the form. Check for errors and try again.

    Alert_accept Thank you for updating your details.