The person's injured limb cannot bear weight during this period. One study claims that in athletes, and if the dislocation is less than 2 mm, the fracture can be managed with casting for six weeks. Options include operative or non-operative treatment. Divergent: metatarsals are displaced in a sagittal or coronal plane and may also involve the intercuneiform area and include a navicular fracture.Isolated: one or two metatarsals are displaced from the others.Lateral displacement may also suggest cuboidal fracture. Homolateral: All five metatarsals are displaced in the same direction.There are three classifications for the fracture: In the case of apparently normal x-rays, if clinical suspicion remains, advanced imaging such as magnetic resonance imaging (MRI) or computed tomography (CT scan) is a logical next step. Unfortunately, radiographs in such circumstances have a sensitivity of 50% when non-weight bearing and 85% when weight bearing, meaning that they will appear normal in 15% of cases where a Lisfranc injury actually exists. Typically, conventional radiography of the foot is utilized with standard non-weight bearing views, supplemented by weight bearing views which may demonstrate widening of the interval between the first and second toes, if the initial views fail to show abnormality. Bruising of the arch has been described as diagnostic in these circumstances but may well be absent. Then, there may only be complaint of inability to bear weight and some mild swelling of the forefoot or midfoot. The diagnosis becomes more challenging in the case of low energy incidents, such as might occur with a twisting injury on the racquetball court, or when an American Football lineman is forced back upon a foot that is already in a fully plantar flexed position. Typical X-ray findings would include a gap between the base of the first and second toes. Further, the nature of the injury will create heightened clinical suspicion and there may even be disruption of the overlying skin and compromise of the blood supply. There will be deformity of the midfoot and X-ray abnormalities should be obvious. In a high energy injury to the midfoot, such as a fall from a height or a motor vehicle accident, the diagnosis of a Lisfranc injury should, in theory at least, pose less of a challenge. This case also has fractures of the distal second (marked by the arrow), third, and fourth metatarsal bones. Diagnosis Lisfranc fracture (marked by the oval). This can also be seen in pivoting athletic positions such as a baseball catcher or a ballerina spinning. American football players occasionally acquire this injury, and it most often occurs when the athlete's foot is plantar flexed and another player lands on the heel. In athletic trauma, Lisfranc injuries occur commonly in activities such as windsurfing, kitesurfing, wakeboarding, or snowboarding (where appliance bindings pass directly over the metatarsals). Examples of this type of trauma include a rider falling from a horse but the foot remaining trapped in the stirrup, or a person falling forward after stepping into a storm drain. Indirect Lisfranc injuries are caused by a sudden rotational force on a plantar flexed (downward pointing) forefoot. ĭirect Lisfranc injuries are usually caused by a crush injury, such as a heavy object falling onto the midfoot, or the foot being run over by a car or truck, or someone landing on the foot after a fall from a significant height. Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents. Such injuries typically involve the ligaments between the medial cuneiform bone and the bases of the second and third metatarsal bones, and each of these ligaments is called Lisfranc ligament. It is these articulations that are damaged in a Lisfranc injury. The midfoot consists of five bones that form the arches of the foot (the cuboid, navicular, and three cuneiform bones) and their articulations with the bases of the five metatarsal bones. Martin, a French surgeon and gynecologist who noticed this fracture pattern amongst cavalrymen in 1815, after the War of the Sixth Coalition. The injury is named after Jacques Lisfranc de St. Lisfranc fracture, Lisfranc dislocation, Lisfranc fracture dislocation, tarsometatarsal injury, midfoot injuryĪ Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.
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