Lisfranc injury: Difference between revisions
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==Epidemiology== | ==Epidemiology== | ||
*20% are missed on first presentation to ED | *20% are missed on first presentation to ED | ||
*Up to 1/3 of | *Up to 1/3 of inuries are from minor slip/fall | ||
== | ==Clinical Features== | ||
*Inability to bear weight (especially on tiptoe) | *Inability to bear weight (especially on tiptoe) | ||
* | *Tenderness over tarsometatarsal region | ||
*Pain with pronation and passive abduction of the midfoot | *Pain with pronation and passive abduction of the midfoot | ||
*Ecchymosis of plantar section of midfoot is highly suggestive | *Ecchymosis of plantar section of midfoot is highly suggestive | ||
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==Imaging== | ==Imaging== | ||
*Fx of base of second metatarsal is pathognomonic | *Fx of base of second metatarsal is pathognomonic | ||
*AP | *AP | ||
*Oblique | **Medial margin of 2nd metatarsal base doesn't align w/ medial margin of 2nd cuneiform | ||
*Lateral | *Oblique | ||
**Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform | |||
*Lateral | |||
**2nd metatarsal is higher than middle cuneiform (step-off) | |||
==Treatment== | ==Treatment== | ||
* | *Sprains and non-displaced fractures: | ||
**Non-weightbearing splint w/ ortho f/u (most pts managed w/ cast x6wk) | |||
*Displaced fractures: | |||
**Emergent ortho consult | |||
*Most Lisfranc fractures require surgery | *Most Lisfranc fractures require surgery | ||
==Complications== | |||
*Must rule-out compartment syndrome | |||
==Source== | |||
*Tintinalli | |||
[[Category:Ortho]] | [[Category:Ortho]] |
Revision as of 23:54, 17 February 2012
Background
- Lisfranc Injury = any fx or dislocation of the tarsal-metatarsal joint
- Lisfranc ligament attaches 2nd metatarsal to medial cuneiform
- 2nd metatarsal is held in mortice created by the three cuneiform bones
- Injury to 2nd metatarsal often results in dislocation of the other MTs
- 2nd metatarsal is held in mortice created by the three cuneiform bones
- Dorsalis pedis may be injured in severe dislocation
Epidemiology
- 20% are missed on first presentation to ED
- Up to 1/3 of inuries are from minor slip/fall
Clinical Features
- Inability to bear weight (especially on tiptoe)
- Tenderness over tarsometatarsal region
- Pain with pronation and passive abduction of the midfoot
- Ecchymosis of plantar section of midfoot is highly suggestive
Imaging
- Fx of base of second metatarsal is pathognomonic
- AP
- Medial margin of 2nd metatarsal base doesn't align w/ medial margin of 2nd cuneiform
- Oblique
- Medial margin of 3rd metatarsal doesn't align w/ medial margin of 3rd cuneiform
- Lateral
- 2nd metatarsal is higher than middle cuneiform (step-off)
Treatment
- Sprains and non-displaced fractures:
- Non-weightbearing splint w/ ortho f/u (most pts managed w/ cast x6wk)
- Displaced fractures:
- Emergent ortho consult
- Most Lisfranc fractures require surgery
Complications
- Must rule-out compartment syndrome
Source
- Tintinalli