A Lisfranc injury (also termed a Lisfranc fracture-dislocation), is the most common type of dislocation involving the foot.
The Lisfranc joint is the articulation of the tarsus with the metatarsal heads, 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's).
There are two types of Lisfranc fracture-dislocation:
A homolateral injury refers to lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains congruent.
A divergent injury is the lateral dislocation of the 2nd to 5th metatarsals with medial dislocation of the 1st metatarsal.
Plain film / CT
These injuries are well demonstrated on the standard views of the foot.
Ancillary imaging techniques are seldom required, although CT examination may demonstrate 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 ligamentous injury. Non-visualisation of the dorsal C1-M2 ligament and a C1-M2 distance > 2.5 mm is indrectly 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 assesing ligamentous injury especially when there is strong clinical concern with routine radiographs being inconclusive 7.
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.
It is named after Jacques Lisfranc De Saint Martin (1790 - 1847) French surgeon 2
- 1. Greenspan A. Orthopedic imaging, a practical approach. Lippincott Williams & Wilkins. (2004) ISBN:0781750067. Read it at Google Books - Find it at Amazon
- 2. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. Radiographics (full text) - Pubmed citation
- 3. Hardcastle PH, Reschauer R, Kutscha-lissberg E et-al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Br. 1982;64 (3): 349-56. J Bone Joint Surg Br (abstract) - Pubmed citation
- 4. Goiney RC, Connell DG, Nichols DM. CT evaluation of tarsometatarsal fracture-dislocation injuries. AJR Am J Roentgenol. 1985;144 (5): 985-90. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. Woodward S, Jacobson JA, Femino JE et-al. Sonographic evaluation of Lisfranc ligament injuries. J Ultrasound Med. 2009;28 (3): 351-7. J Ultrasound Med (full text) - Pubmed citation
- 6. Macmahon PJ, Dheer S, Raikin SM et-al. MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament. Skeletal Radiol. 2009;38 (3): 255-60. doi:10.1007/s00256-008-0613-6 - Pubmed citation
- 6. Crim J. MR imaging evaluation of subtle Lisfranc injuries: the midfoot sprain. Magn Reson Imaging Clin N Am. 2008;16 (1): 19-27, v. doi:10.1016/j.mric.2008.02.007 - Pubmed citation
- 7. Preidler KW, Brossmann J, Daenen B et-al. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. AJR Am J Roentgenol. 1996;167 (5): 1217-22. AJR Am J Roentgenol (abstract) - Pubmed citation
- 8. Jones EA, Manaster BJ, May DA et-al. Neuropathic osteoarthropathy: diagnostic dilemmas and differential diagnosis. Radiographics. 2000;20 Spec No : S279-93. Radiographics (full text) - Pubmed citation
- 9. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol. 2004;183 (3): 615-22. AJR Am J Roentgenol (full text) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|