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Lisfranc injury

Case contributed by Rozanne Visvalingam
Diagnosis certain

Presentation

Fall down stairs after missed step.

Patient Data

Age: 60 years
Gender: Male

Fall down stairs

x-ray

Visible on the AP projection is a subtle widening of the Lisfranc interspace. On the oblique view there is widening of the space between the base of 2nd and 3rd metatarsals. A visible lucency is also seen in the lateral cuneiform indicating a fracture. The lateral margin of 5th metatarsal projects >3 mm over cuboid on the oblique view.

Lisfranc injury

Annotated image

Multiple findings consistent with Lisfranc injury.

Intra-operative film

Fluoroscopy

Horseshoe plate to compress Lisfranc fracture inserted two weeks after initial injury.

Case Discussion

Lisfranc injury is very important to recognize as it can lead to arthritis and disability if not repaired. Signs are often more apparent on the oblique view of the foot. A common mechanism of injury is forced plantar-flexion of the foot which can occur with missing a step when descending stairs, as described in this case.

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