Presentation
A truck ran over the patient's left foot. Gustilo type IIIC open fracture. Hallux with signs of ischemia on presentation.
Patient Data
Foot and ankle radiographs revealed a Lisfranc fracture-dislocation, most noticeable at the frontal ankle radiograph by the increased distance between the medial cuneiform and 2nd metatarsal as well as the increased distance between the 1st and 2nd metatarsals.
Multiple associated injuries are present:
- comminuted fracture of the 1st metatarsal with considerable displacement and bone loss
- displaced fracture of the neck of the 2nd and 3rd metatarsals
- fracture of the bases of the 2nd and 3rd metatarsals
Case Discussion
A Lisfranc injury (or tarsometatarsal injury) is a rare, yet extremely important, possible repercussion of trauma to the foot.
In the present case, the injury was due to an extremely high energy trauma to the foot. The associated fractures made the presentation much more complex.
The orthopedic surgery and the vascular surgery teams discussed the case and agreed the best initial management was the amputation of the 1st, 2nd, and 3rd toes.
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