Lisfranc injury - type A homolateral complete incongruity

Case contributed by Leo Martinez

Presentation

Trauma

Patient Data

Age: 30 years
Gender: Male

Lateral dislocation of the first and second metatarsals relative to the medial and middle cuneiforms respectively. Comminuted fracture of the cuboid. Mildly displaced fractures of the third and second metacarpal necks. Laterally displaced, angled-related fracture of the fourth metacarpal neck. Mildly displaced intraarticular fracture at the base of the proximal phalanx of the great toe. Soft tissue swelling around the midfoot. 

Homolateral Lisfranc fracture-dislocation with additional fractures distally in the second through fourth metatarsals and medial base of the first proximal phalanx.

Postoperative findings after open treatment of tarsometatarsal joint dislocation including internal fixation. 5 joints were reduced, 4 joints fixed, the second joint with a 4 hole 2.7 plate and screws, and the first, fifth, and fourth joints with 2.0 K wires. Also, closed treatment of second, third, and fourth metatarsal neck fractures was performed.

Case Discussion

Lisfranc fracture-dislocations are important injuries to identify given their association with midfoot arch collapse and osteoarthritis. This case illustrates a type A homolateral Lisfranc injury that underwent open reduction and internal fixation. 

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