Tarsometatarsal Lisfranc Injuries: A Diagnostic Challenge

Main Article Content

Nitin Patil
Amit Garud
S. V. Goutam
Sandeep Shirahatti

Abstract

Introduction: Lisfranc injuries are often difficult to diagnose and treat causing long term disability without proper management. Lisfranc injuries refer to bony or ligamentous compromise of the tarsometatarsal and intercuneiform joint complex. Improper treatment of these fractures might lead to negative outcomes such as soft tissue necrosis, posttraumatic arthritis and arch abnormalities. This study aims to help in diagnosis and treatment of tarsometatarsal Lisfranc injuries.

Materials and Methods: Study comprises of 10 patients diagnosed with Lisfranc injury. All of them were treated with open reduction and internal fixation. Post-operatively, all patients were assessed using AOFAS midfoot scale for outcome after the surgery and scores were recorded at each follow up and final results were evaluated after 1 year of surgery.

Observation and Results: Mean AOFAS midfoot score was 82 at the end of one year. Majority of the patients had AOFAS score of more than 80. Majority of patients had B2 type of fracture according to Meyerson Classification.

Conclusion: Anatomical reduction is the key for the treatment of lisfranc injuries, therefore, open reduction and internal fixation is necessary to provide good outcome.

Keywords:
Lisfranc injuries, intercuneiform joint complex, ligamentous compromise

Article Details

How to Cite
Patil, N., Garud, A., Goutam, S. V., & Shirahatti, S. (2020). Tarsometatarsal Lisfranc Injuries: A Diagnostic Challenge. Asian Journal of Orthopaedic Research, 3(2), 13-21. Retrieved from http://journalajorr.com/index.php/AJORR/article/view/30117
Section
Original Research Article

References

Clare MP. Lisfranc injuries. Curr Rev Musculoskelet Med. 2017;10(1):81–85.
DOI: 10.1007/s12178-017-9387-6

Nithyananth M, Boopalan PR, Titus VT, Sundararaj GD, Lee VN. Long-term outcome of high-energy open Lisfranc injuries: A retrospective study. J Trauma. 2011;70:710–6.

Peicha G, Labovitz J, Seibert FJ, et al. The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study. J Bone Joint Surg Br. 2002;84(7):981-985.

Gotha, Heather & Lareau, Craig & Fellars, Todd. Diagnosis and management of lisfranc injuries and metatarsal fractures. Rhode Island Medical Journal. 2013;96:33-6. Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: Current concepts. J Am Acad Orthop Surg. 2010; 18(12):718-728.

Goossens M, DeStoop N. Lisfranc’s fracture-dislocations: Etiology, radiology, and results of treatment. Clin Orthop Relat Res. 1983;176:154–62.

Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am. Dec 1990;72(10):1519-1522.

Aronow MS. Treatment of the missed Lisfranc injury. Foot Ankle Clin. 2006; 11(1):127-142,ix.

Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC. Prediction of mid foot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Joint Surg Am. 2009;91:892–9.

Curtis M, Myerson M, Szura B. Tarsometatarsal injuries in the athlete. Am J Sports Med. 1994;21:497–502.

Sangeorzan BJ, Veith RG, Hansen ST. Salvage of Lisfanc’s tarsometatarsal joints by arthrodesis. Foot Ankle Int. 1990;4:193–200.

Komenda GA, Myerson MS, Biddinger KR. Results of arthrodesis of the tarso-metatarsal joints after traumatic injury. J Bone Joint Surg Am. 1996;78A:1665–76.

Cassinelli SJ, Moss LK, Lee DC, Phillips J, Harris TG. Delayed open reduction internal fixation of missed, low-energy Lisfranc injuries. Foot Ankle Int; 2016.

Nunley JA, Vertullo CJ. Classification, investigation and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 2002;30(6):871–878.

Demirkale I, Tecimel O, Celik I, Kilicarslan K, Ocguder A, Dogan M. The effect of the Tscherne injury pattern on the outcome of operatively treated Lisfranc fracture dislocations. Foot Ankle Surg. 2013;19: 188–93.