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.
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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.
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).
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
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.
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.
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.
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.
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